Fractal Analysis of Mandibular Condylar Trabecular Bone Structure in Cone-Beam Computed Tomography Images of Individuals with Cleft Lip and Palate

Objective To evaluate mandibular condylar trabecular bone structure in individuals with cleft lip and palate (CLP) using cone-beam computed tomography (CBCT)-based fractal analysis. Design Retrospective imaging study. Setting Departmental dentomaxillofacial radiology archive. Patients, Participants CBCT images of 33 individuals with CLP (11 right-sided unilateral, 16 left-sided unilateral, and 6 bilateral clefts) and 38 individuals without CLP with a comparable age distribution were analyzed. Interventions Not applicable. Main Outcome Measure(s) Fractal dimension (FD) values of the right and left mandibular condyles measured on standardized coronal, sagittal, and axial CBCT sections. Intra- and interobserver agreement were assessed with intraclass correlation coefficients. Results Intra- and interobserver agreement was excellent (ICC > 0.90). FD values tended to be lower in individuals with CLP than in individuals without CLP. After Benjamini–Hochberg false discovery rate correction for multiple comparisons, only the between-group difference in the left sagittal plane remained statistically significant (FDR-adjusted p = . 018). No significant group-by-side interaction was observed in the coronal, sagittal, or axial planes (all FDR-adjusted p > . 05). In individuals with unilateral CLP, no significant ipsilateral–contralateral differences in condylar FD were observed. Conclusions Individuals with CLP tended to show lower mandibular condylar FD values than individuals without CLP; however, the between-group difference did not differ significantly between the right and left sides. These findings suggest that CLP may be associated with radiographically detectable differences in condylar trabecular bone complexity. Larger longitudinal studies are needed to clarify the clinical and functional relevance of these findings.