Impairment in facial expression generation in patients with repaired unilateral cleft lip: Effects of the physical properties of facial soft tissues

Patients with repaired unilateral cleft lip with palate (UCLP) often show dysmorphology and distorted facial motion clinically, which can cause psychological issues. However, no report has clarified the details concerning distorted facial motion and the corresponding possible causative factors. In this study, we hypothesized that the physical properties of the scar and surrounding facial soft tissue might affect facial displacement while smiling in patients with UCLP (Cleft group). We thus examined the three-dimensional (3D) facial displacement while smiling in the Cleft and Control groups in order to determine whether or not the physical properties of facial soft tissues differ between the Cleft and Control groups and to examine the relationship between the physical properties of facial soft tissues on 3D facial displacement while smiling. Three-dimensional images at rest and while smiling as well as the facial physical properties (e.g. viscoelasticity) of both groups were recorded. Differences in terms of physical properties and facial displacement while smiling between the two groups were examined. To examine the relationship between facial surface displacement while smiling and physical properties, a canonical correlation analysis (CCA) was conducted. As a result, three typical abnormal features of smiling in the Cleft group compared with the Control group were noted: less upward and backward displacement on the scar area, downward movement of the lower lip, and a greater asymmetric displacement, including greater lateral displacement of the subalar on the cleft side while smiling and greater alar backward displacement on the non-cleft side. The Cleft group also showed greater elastic modulus at the upper lip on the cleft side, suggesting hardened soft tissue at the scar. The CCA showed that this hard scar significantly affected facial displacement, inducing less upward and backward displacement on the scar area and downward movement of the lower lip in patients with UCLP (correlation coefficient = 0.82, p = 0.04); however, there was no significant relationship between greater nasal alar lateral movement and physical properties of the skin at the scar. Based on these results, personalizing treatment options for dysfunction in facial expression generation may require quantification of the 3D facial morphology and physical properties of facial soft tissues.