Introduction

Post-surgical outcomes in patients with unilateral cleft lip and palate (CUCLP) often focus on functional success, such as speech and feeding. However, achieving ideal smile aesthetics remains a significant challenge for reconstructive teams. This recent study employed the Akhter-Anne framework smile analysis to objectively evaluate these outcomes against non-cleft controls. Consequently, the findings highlight specific areas where current surgical interventions may leave persistent aesthetic gaps.

Study Methodology and Design

Researchers conducted a cross-sectional comparative study to assess smile components in 30 CUCLP patients. These individuals, aged between 16 and 30 years, had previously undergone surgical correction. The team compared them with 30 age- and sex-matched non-cleft controls. To ensure precision, the researchers used MAKHTER software and the Akhter-Anne Smile Diagram. This tool allowed for a comprehensive evaluation of facial, nasal, labial, nasolabial, and dento-gingival domains.

Persistent Deficits Revealed by Akhter-Anne Framework Smile Analysis

The results indicated that while the overall facial component showed no significant differences, other domains exhibited marked deficits. Specifically, the Akhter-Anne framework smile analysis identified that CUCLP patients had significantly reduced philtrum height compared to controls. Furthermore, these patients demonstrated shorter upper lip lengths and narrower commissure widths. In addition, nasal width was significantly higher in the CUCLP group, suggesting a persistent widening of the nasal base despite previous surgeries.

Clinical Implications for Surgeons

These findings suggest that traditional surgical repairs may not fully restore the complex three-dimensional aesthetics of the smile. Specifically, the persistent labial shortening and nasal widening indicate a need for refined primary or secondary procedures. Therefore, clinicians should consider these specific metrics when planning revisions or secondary cheiloplasty. Moreover, the Akhter-Anne framework provides a standardized method for tracking these aesthetic outcomes over time. Ultimately, this objective data can guide better surgical strategies for achieving facial harmony.

Frequently Asked Questions

What is the Akhter-Anne framework smile analysis?

It is a pictorial and quantitative chart designed to record various smile parameters across facial, perioral, and dentogingival zones in a single diagram. It helps clinicians identify specific aesthetic deficits objectively.

Why do CUCLP patients often have reduced philtrum height?

Reduced philtrum height often results from scar contracture or tissue deficiency inherent in the initial cleft deformity. Surgical repair aims to restore this, but persistent shortening is common due to growth patterns and scar tissue.

How does nasal width impact the overall smile aesthetic?

Increased nasal width often correlates with nasal base flaring. This can disrupt the nasolabial balance, making the smile appear less symmetrical and highlighting the previous cleft site despite successful lip closure.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice and is not a substitute for professional clinical judgment. Refer to the latest local and national guidelines for clinical practice.

References

1. Sera Noel AT et al. Comprehensive Smile Component Analysis in Unilateral Cleft Lip and Palate Using Akhter-Anne Framework. Cleft Palate Craniofac J. 2026 Feb 25. doi: 10.1177/10556656261426215. PMID: 41739550.

2. Husain A, Bronkhorst EM, Bhat HK, Kuijpers MAR, Koya S, Kuijpers-Jagtman AM. A novel pictorial smile chart: Reliability and validity. Am J Orthod Dentofacial Orthop. 2023 Aug;164(2):215-225. doi: 10.1016/j.ajodo.2022.12.012. PMID: 36907720.