Which cephalometric characteristic is most commonly found in adult patients with repaired unilateral cleft lip and palate?

 # Which cephalometric characteristic is most commonly found in adult patients with repaired unilateral cleft lip and palate?

A. Maxillary prognathism

B. Increased midface height

C. Maxillary retrusion and Class III tendency

D. Mandibular retrognathism

The correct answer is C. Maxillary retrusion and Class III tendency.

Reasoning

Adult patients with repaired unilateral cleft lip and palate (UCLP) typically exhibit a specific craniofacial morphology due to the restrictive effects of primary surgical repairs (particularly palatoplasty) on maxillary growth.

• Maxillary Retrusion: The formation of scar tissue from surgical repair inhibits the anteroposterior and transverse growth of the maxilla. This is the most consistent and prominent cephalometric characteristic.

• Class III Skeletal Pattern: Because the mandible generally usually exhibits normal growth potential (though it may be slightly retrognathic or rotated), the deficient maxilla results in a relative mandibular prognathism, creating a skeletal Class III relationship (ANB angle reduction or inversion).

• Vertical Dimensions: While midface height can be affected, the reduced anterior face height or vertical maxillary deficiency is more common than increased midface height, often contributing to a "closed" bite tendency or requiring surgical advancement that includes vertical lengthening.

Why other options are incorrect:

• A. Maxillary prognathism: The maxilla is typically hypoplastic (underdeveloped), not prognathic.

• B. Increased midface height: The midface is usually vertically deficient (hypoplastic).

• D. Mandibular retrognathism: While the mandible may sometimes be slightly smaller or rotated, the defining characteristic of the Class III appearance is the maxillary deficiency, not the mandibular position. The mandible often appears prognathic relative to the retrusive maxilla.