Anatomical insights into midface retrusion and maxillary hypoplasia in adult cleft lip and palate patients post-skeletal maturity

Background: Cleft lip and palate (CLP) is a common congenital anomaly affecting the maxillofacial region, influenced by genetic and environmental factors. This study aims to investigate facial development in adult CLP patients and compare it with healthy controls. Methods: A total of 67 adult CLP patients and 67 healthy controls were included in this study. All participants underwent cephalometric analysis using computed tomography (CT) scans taken in a closed-mouth position. Various cephalometric parameters, including SNA, SNB, SNPog angles, NL-ML, NSL-ML, NSL-NL, N-ANS, ANS-Me, N-Me, PMP-A, S-PMP, and S-Go lengths, were measured. Statistical comparisons between groups were conducted using Mann-Whitney U, Student's t, and Welch's t-tests, with p < 0.05 considered statistically significant. Significant differences were observed between CLP patients and controls in several parameters. SNA and PMP-A values were lower in the CLP group, indicating midface retrusion and effective maxillary hypoplasia. Results: NSL-NL angles were higher in CLP patients, reflecting an increased palatal plane angle. SNB and SNPog values were also lower in CLP patients, indicating mandibular retrusion. N-ANS and total facial height (N-Me) were greater in the CLP group, while ANS-Me and posterior maxillofacial lengths (S-PMP and S-Go) showed no significant differences. Conclusions: Adult CLP patients exhibit significant deviations in facial development compared to healthy controls, characterized by midface retrusion, effective maxillary hypoplasia, and increased vertical facial dimensions. These findings highlight the complex interplay between intrinsic growth deficiencies and surgical interventions, underscoring the need for tailored treatment strategies to optimize facial development outcomes in CLP patients.