PURPOSE: The mandibular condyle is important to facial growth, but its role in mandibular asymmetry in patients with cleft lip and/or palate (CLP) is poorly described.
METHODS: Condylar volumetric asymmetry was obtained by generating three-dimensional reconstructions of computed tomography scans on Mimics Version 23.0. Relationships among variables were compared with appropriate statistics.
RESULTS: Our cohort of 119 skeletally mature patients consisted of 60 (50%) CLP who underwent orthognathic surgery, 18 (15%) CLP who did not, and 41 (35%) controls. Condylar volumes in CLP who had orthognathic surgery were more asymmetric than CLP who did not have orthognathic surgery (16.4±17.4% vs 7.0±4.7%, p<0.05). CLP without an orthognathic surgical history had similar condylar volumetric asymmetry to controls (7.0±4.7% vs 5.9±3.8%, p>0.05). CLP with clinically significant chin deviation (>4 mm) had more asymmetric condyles than those without significant chin deviation (p=0.003). The chin deviated toward the smaller condyle in patients with facial asymmetry more often than in patients without facial asymmetry (81% vs. 62%, p=0.033). On receiver operating characteristic curve analysis, condylar volume predicted the need for orthognathic surgery in CLP with a sensitivity of 70% and specificity of 67%.
CONCLUSION: Patients with cleft lip and/or palate who had orthognathic surgery have more asymmetric condyles than CLP without an orthognathic surgical history and the general population. Facial asymmetry in CLP is associated with increased condylar asymmetry, with the facial midline deviating toward the smaller condyle. Condylar volumetric asymmetry can help predict the need for orthognathic surgery in CLP with moderate accuracy.