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The aim of this retrospective, cross\u2010sectional investigation was to quantify directional asymmetry (DA) of the facial skeleton of children born with Veau Class IV nonsyndromic BCLP. To accomplish this goal, coordinate values of anatomical landmarks were acquired from three\u2010dimensional cone beam computed tomographic images of the craniofacial skeleton of middle\u2010 to late\u2010aged children born with BCLP and age\u2010 and sex\u2010matched controls and used to compare patterns of asymmetry variation. Multivariate analyses revealed different patterns of DA variation across samples and identified approximately 30% of DA measures as significantly different. Magnitudes of statistically significant linear distances differ in the craniofacial region, with most smaller DA differences located near the orbits and frontal bone, while larger differences were localized mostly to the midface, alveolar ridge, and nasal borders. Generally, areas of the craniofacial skeleton derived from the maxillary and nasal prominences demonstrated the highest magnitudes of DA. The methods and results presented will be useful to biomedical researchers when identifying the extent to which patients with BCLP diverge from typical developmental expectations. Quantifying DA and assessing local differences across the craniofacial complex can aid medical practitioners when developing treatments to improve BCLP surgical algorithms and outcomes. Anat Rec, 302:1726\u20131732, 2019. \u00a9 2019 American Association for Anatomy<\/jats:p>","DOI":"10.1002\/ar.24111","type":"journal-article","created":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T10:03:43Z","timestamp":1552125823000},"page":"1726-1732","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Breaking Symmetry: A Quantitative Analysis of Facial Skeleton Disharmony in Children Born with Bilateral Cleft Lip and Palate"],"prefix":"10.1002","volume":"302","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0962-4285","authenticated-orcid":false,"given":"Nicole","family":"Santana","sequence":"first","affiliation":[{"name":"Department of Biology University of Central Florida  Orlando Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Starbuck","sequence":"additional","affiliation":[{"name":"Department of Anthropology University of Central Florida  Orlando Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,27]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"AdeyemiTA.2015.Cleft lip and palate care in Nigeria. 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