Indiacran: An Intercentre Assessment of Craniofacial Form for Patients With Repaired Complete Unilateral Cleft Lip and Palate

OBJECTIVE: To analyse and compare the craniofacial characteristics of patients with nonsyndromic, surgically repaired, complete unilateral cleft lip and palate, aged 8-14 years, treated at 10 cleft care centres. METHODS: Lateral cephalograms of 396 patients (mean age 11.2 ± 1.6 years; male: female ratio 1:0.64) with unilateral cleft lip and palate from 10 comprehensive cleft care centres across India were evaluated using NemoStudio cephalometric software. Cephalograms were anonymised, coded and digitised for unbiased assessment. Two orthodontists independently traced all radiographs at different time intervals. Eleven hard-tissue and seven soft-tissue cephalometric variables were measured on each radiograph. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: Cephalometric analysis demonstrated statistically significant intercentre differences for sagittal skeletal and soft-tissue parameters, including SNA, SNB, ANB, ANS-Me/N-Me, NAPog, nasolabial angle, N'A'Pog' and A'N'B'. In contrast, other parameters did not differ significantly among centres. Dental inclination variables Ui-PP and Li-MP also showed no significant differences. Inter-rater reliability was moderate to good, with ICC values of 0.51-0.85. CONCLUSIONS: Considerable intercentre variation was observed in sagittal hard- and soft-tissue craniofacial parameters among children with repaired unilateral cleft lip and palate. However, these variations cannot be attributed to any single component of the treatment protocol. Instead, it reflects the multifactorial nature of cleft care, including variations in surgical timing, technique, presurgical orthopaedics and patient-related factors.