Using three-dimensional average facial meshes to determine nasolabial soft tissue deformity in adult UCLP patients.

BACKGROUND AND PURPOSE: There is limited literature discussing the residual nasolabial deformity of adult patients prior to undergoing orthognathic surgery. The purpose of this study is to determine the site and severity of the residual nasolabial soft tissue deformity between adult unilateral cleft lip and palate (UCLP) patients and a non-cleft reference group, prior to orthognathic surgery. MATERIAL AND METHODS: Sixteen adult male UCLP patients, who all received primary lip and palate surgery according to a standardised Hong Kong protocol were recruited for this study. Facial images of each individual were captured using three-dimensional (3D) stereophotogrammetry and compared to a previous published Hong Kong non-cleft reference group of 48 male adults. Using two-sample t-tests differences in linear and angular measurements and asymmetry scores were evaluated between the two groups. In addition a "conformed" average UCLP facial template was superimposed and compared to conformed average non-cleft reference group facial template. Reproducibility of the measurements were assessed using Students paired t-tests and coefficients of reliability. MAIN FINDINGS: Significant differences in linear and angular measurements and asymmetry scores were observed between the two groups (p < 0.05). Adult UCLP patients showed significantly narrower nostril floor widths, longer columella length on the unaffected side, a wider nose, shorter cutaneous lip height, shorter upper lip length and shorter philtrum length. Prior to orthognathic surgery adult UCLP patients showed significantly more facial asymmetry. Superimposition of the average facial meshes clearly showed the site and severity of the deficiency in the x, y and z-directions. CONCLUSIONS: Many of the nasolabial characteristics reported to be present in children following primary UCLP repair continue into adulthood. The detrimental soft tissue effects of orthognathic surgery for UCLP patients may be different to non-cleft individuals; and as such the site and severity of the residual deformity should be assessed prior to surgery.

Oral cancer teaching of medical students in the UK: time for a new approach?

Many patients with oral lesions present to general medical practitioners (GMPs). GMPs are also more likely to see patients with higher oral cancer risk. Therefore, GMPs play an important role in the early detection and prevention of oral cancer but is this reflected in undergraduate medical teaching. A questionnaire regarding oral cancer teaching was delivered to the curriculum directors of all UK medical schools. A response rate of 66% was achieved. There was wide variation in teaching time, teaching methods employed, and specialties involved. Sixty percent of schools provided clinical examination of patients with oral lesions. Up to 55% of medical schools included oral cancer in student assessment. There is wide variation in oral cancer teaching in UK medical schools. There is a need to develop a curriculum that addresses the important aspects of oral cancer from an evidence-based consensus approach.