Effect of cleft lip and palate on mandibular condylar volume and dimensions using cone-beam computed tomography

Effect of cleft lip and palate on mandibular condylar volume and dimensions using cone-beam computed tomography | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Effect of cleft lip and palate on mandibular condylar volume and dimensions using cone-beam computed tomography Rana Mahjoobi Acsil, Ahmad Reza Tallaeipoor, Sandra Mehralizadeh, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2934380/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Introduction: This study aimed to assess the effect of cleft lip and palate (CLP) on mandibular condylar volume and dimensions using cone-beam computed tomography (CBCT). Methods This cross-sectional study was conducted on the head and neck, and temporomandibular joint (TMJ) CBCT scans of 18 patients with unilateral CLP (UCLP) and 18 non-cleft controls with class I occlusion. The mediolateral and anteroposterior dimensions and height and volume of the right and left condyles were measured by the ITK-SNAP software. Comparisons were made by one-way ANOVA and paired sample t-test (alpha = 0.05). Results The mediolateral dimension of the condyle of the affected side in UCLP patients was significantly smaller than the right and left condyles in healthy controls (mean difference of 2.33 mm, P = 0.002). This value at the unaffected side of UCLP patients was also significantly smaller than the right and left condyles in healthy controls (mean difference of 2.05, P = 0.005). Anteroposterior dimension, and condylar height and volume at the affected and unaffected sides of UCLP patients were not significantly different within group, or when compared with healthy controls (P > 0.05). Conclusions Only the mediolateral width of the condyle at both sides in UCLP patients was significantly smaller than the values in the right and left condyles of non-cleft controls. Health sciences/Health care Health sciences/Health care/Dentistry/Occlusion Cleft Lip with or without Cleft Palate Nonsyndromic Cone-Beam Computed Tomography Mandibular Condyle Figures Figure 1 Figure 2 Introduction Cleft lip and palate (CLP) are one of the most common congenital anomalies that occur as the result of genetic and environmental factors. 1 Its global prevalence rate is 1 per 1000 births. 2 CLP patients suffer significant impairments in maxillofacial and dental growth and development, which cause malocclusion and esthetic problems. 3 In general, the morphology of the craniofacial structures such as the maxilla and mandible in CLP patients is different from that in healthy individuals due to a different growth pattern and the implemented treatments. 4 Evidence shows that anterior and posterior cross-bites are common in such patients 5 , and such occlusal interferences especially unilateral posterior cross-bite cause over-function of the muscles at the site, which changes the center of temporomandibular joint (TMJ) growth over time. The reason is that the mandibular condyle is among the most sensitive areas to occlusal changes and interferences. 6 Loads applied to the TMJ cause bone remodeling and change the thickness and shape of the bony components such as the condyle and glenoid fossa. Such changes increase the risk of asymmetry of the mandible, and subsequent esthetic problems and temporomandibular disorders. 7 Auricular pain, masticatory muscle pain, mandibular movement limitation, mouth opening limitation, articular sounds, headache, and orofacial pain are among the signs and symptoms of temporomandibular disorders. 8 Several studies have assessed the dimensions and volume of the condyle in CLP patients. For instance, Kim et al. 9 found no significant difference in condylar volume of the affected and unaffected sides in CLP patients. Shresta et al. 10 detected no significant difference in volume of the mandible in CLP patients and healthy controls. However, Celikoglu et al. 11 reported smaller mandibular volume in CLP patients than healthy controls, and Uçar et al. 12 showed smaller condylar volume in bilateral CLP patients compared with the control group. Considering the existing controversy in the literature and absence of studies comparing the condylar volume of the affected and unaffected sides in unilateral CLP (UCLP) patients, or with a healthy control group, this study aimed to assess the effect of UCLP on the condylar volume and dimensions in comparison with healthy controls using cone-beam computed tomography (CBCT). Materials and methods Study population: This cross-sectional study was conducted on 18 head and neck, and TMJ CBCT scans of patients taken at the Radiology Department of School of Dentistry, Islamic Azad University, and a private radiology center between 2011 and 2018 with definite diagnosis of UCLP. Eighteen CBCT scans of healthy controls were also selected which had been taken for other indications such as assessment of an impacted tooth or orthodontic treatment. The study protocol was approved by the ethics committee of the university (IR.IAU.DENTAL.REC.1400.117). Eligibility criteria: The inclusion criteria were age between 15–22 years and having undergone surgical closure of the lip and hard tissue before the age of 3.5 years for UCLP patients. The exclusion criteria were history of previous orthodontic treatment, history of orthognathic surgery, history of trauma, systemic diseases and syndromic conditions, history of an articular degenerative disease, and bilateral CLP cases. The patients were selected by targeted sampling. Sample size: The minimum sample size for condylar volume was calculated to be 18 individuals in each group according to a study by Uçar et al, 12 assuming alpha = 0.05, beta = 0.10, mean standard deviation of condylar volume to be 38.5 mm 3 and effect size of 0.85. The sample size for other variables was calculated to be lower than 18. Measurements: All CBCT scans had been taken with NewTom VGi CBCT scanner (Verona, Italy) with the exposure settings of 110 kVp, 2–29 mA, and 15 x 15 cm field of view, and Rotograph Evo 3D scanner (Villa Sistemi Medicali, Buccinasco, Italy) with the exposure settings of 88 kVp, 9 mA, and 5.8 x 5.8 cm field of view, with patients in upright position and teeth in maximum intercuspation. The images were then converted to DICOM format by NNT Viewer software version 2.21 (Quantitative Radiology, Verona, Italy). The images were three-dimensionally reconstructed by the ITK-SNAP 3.8.0 software (Paul A. Yushkevich, Guido Gerig, Chapell Hill, North Carolina, USA) and evaluated in coronal, sagittal, and axial sections. On the cross-sectional slices of each condyle with 1 mm slice thickness in the axial view, the innermost and outermost points of the condylar head were identified and the distance between them was recorded as the mediolateral width of the condyle in tenth of a millimeter. On the axial view, the most anterior and most posterior points of the condylar head were identified and the distance between them was recorded as the anteroposterior dimension of the condyle at each side. Of different slices in the coronal view, the slice showing the uppermost point of the condyle was selected, and its vertical distance from the condylar plane was recorded as the condylar height. The condylar plane is the inferior limit of the condyle, which is parallel to the horizon and passes through the deepest point of the sigmoid notch. All measurements were made in the ITK-SNAP software by using its ruler feature (Fig. 1 ). 9 , 12 To quantify the condylar volume, part of the condyle superior to the condylar plane was considered. To determine the region of interest, the Snake tool was used to outline the superior, inferior, anterior, posterior, medial, and lateral borders of the condyle on multiplanar images. Following segmentation, bubbles were manually created at different parts of the condyle in the coronal, sagittal, and axial planes to determine its primary contour. Next, a semi-automatic 3D model of the condyle was designed by the software and its volume was quantified in cubic millimeters (mm 3 ) (Fig. 2 ). 13 Statistical analysis: One-way ANOVA was applied to compare the UCLP and control groups regarding the condylar volume and dimensions. Paired sample t-test was used to compare the values between the affected and unaffected sides in UCLP patients. P < 0.05 was considered statistically significant. Results Table 1 presents the condylar dimensions and volume in UCLP patients and non-cleft control group. Table 1 Condylar dimensions and volume in UCLP patients and control group Levene's Test for Equality of Variances t-test for Equality of Means F Sig. t df Sig. (2-tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper Mediolateral condylar dimension of unaffected side Equal variances assumed 0.034 0.856 -2.998 34 0.005 -2.0556 0.6855 -3.4488 -0.6624 Equal variances not assumed -2.998 34.000 0.005 -2.0556 0.6855 -3.4488 -0.6624 Mediolateral condylar dimension of Affected side Equal variances assumed 0.023 0.880 -3.292 34 0.002 -2.3333 0.7088 -3.7739 -0.8928 Equal variances not assumed -3.292 33.878 0.002 -2.3333 0.7088 -3.7741 -0.8926 Anteroposterior condylar dimension of unaffected side Equal variances assumed 0.298 0.588 0.125 34 0.902 0.0500 0.4012 -0.7654 0.8654 Equal variances not assumed 0.125 32.162 0.902 0.0500 0.4012 -0.7671 0.8671 Anteroposterior condylar dimension of affected side Equal variances assumed 1.383 0.248 -0.630 34 0.533 -0.3444 0.5466 -1.4553 0.7664 Equal variances not assumed -0.630 32.476 0.533 -0.3444 0.5466 -1.4572 0.7683 Condylar length of unaffected side Equal variances assumed 6.669 0.014 0.379 34 0.707 0.4333 1.1437 -1.8909 2.7575 Equal variances not assumed 0.379 26.728 0.708 0.4333 1.1437 -1.9144 2.7811 Condylar length of affected side Equal variances assumed 6.167 0.018 0.167 34 0.868 0.2167 1.2979 -2.4210 2.8544 Equal variances not assumed 0.167 28.842 0.869 0.2167 1.2979 -2.4385 2.8719 Condylar volume of unaffected side Equal variances assumed 0.567 0.457 -1.224 34 0.229 -200.9167 164.0958 -534.3995 132.5662 Equal variances not assumed -1.224 33.976 0.229 -200.9167 164.0958 -534.4083 132.5750 Condylar volume of affected side Equal variances assumed 0.058 0.810 -1.237 34 0.224 -207.9611 168.0648 -549.5099 133.5877 Equal variances not assumed -1.237 33.366 0.225 -207.9611 168.0648 -549.7491 133.8269 Mediolateral dimension of the condyle: UCLP patients had a significantly smaller mediolateral condylar dimension at the affected side compared with the right and left condyles of the healthy control group (P = 0.002). This parameter in the unaffected condyle of UCLP patients was also significantly smaller than that in the right and left condyles of the healthy control group (P = 0.005). Anteroposterior dimension of the condyle: This parameter in the affected side of UCLP patients had no significant difference with the right and left condyles of the healthy control group (P = 0.533). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P = 0.902). Condylar height: In UCLP patients, this parameter in the affected side had no significant difference with the right and left condyles of the healthy control group (P = 0.868). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P = 0.707). Condylar volume: In UCLP patients, this parameter in the affected side had no significant difference with the right and left condyles of the healthy control group (P = 0.224). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P = 0.229). Table 2 presents the comparison of condylar dimensions and volume between the affected and unaffected sides in UCLP patients. As shown, no significant difference existed in the affected and unaffected sides regarding mediolateral condylar dimension (P = 0.611), anteroposterior condylar dimension (P = 0.618), condylar length (P = 0.668), or condylar volume (P = 0.691). Table 2 Comparison of condylar dimensions and volume between the affected and unaffected sides in UCLP patients Paired Samples Test Paired Differences Mean Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference t df Sig. (2- tailed) Lower Upper Mediolateral condylar dimension of the affected and unaffected sides 0.2222 1.8197 0.4289 -0.6827 1.1271 0.518 17 0.611 Anteroposterior condylar dimension of the affected and unaffected sides 0.1167 0.9739 0.2296 -0.3677 0.6010 0.508 17 0.618 Condylar length of the affected and unaffected sides -0.3056 2.9688 0.6997 -1.7819 1.1708 -0.437 17 0.668 Condylar volume of the affected and unaffected sides -52.9556 556.5061 131.1697 -329.6995 223.7884 -0.404 17 0.691 Discussion This study assessed the effect of UCLP on the condylar volume and dimensions in comparison with healthy controls using CBCT. Use of CBCT for data collection in the present study was due to its 3D nature and the fact that it can provide valuable information regarding malocclusion and dentoskeletal problems in CLP patients. 10 , 14 , 15 Two-dimensional imaging modalities have distortion and magnification errors and cannot provide accurate information in this regard. 16 , 17 The present results showed that UCLP patients had significantly smaller mediolateral condylar dimension in both the affected and unaffected sides compared with the control group. Veli et al. 14 evaluated 15 UCLP patients and found no significant difference in mediolateral width of the condyle and condylar height of the affected and unaffected sides of UCLP patients and healthy controls. Similarly, Uçar et al. 12 found no significant difference in mediolateral condylar width of bilateral CLP patients and healthy control group. Their results were different from the present findings which may be due to evaluation of bilateral CLP patients in the latter study or different reference points used for the measurements. In the present study, the anteroposterior condylar dimension in the affected and unaffected sides in UCLP patients had no significant difference with the corresponding values in the control group. The difference in condylar height was not significant either, which was in agreement with the findings of Veli et al, 14 who calculated the condylar height from the uppermost point of the condyle to the lowermost point of the mandibular foramen. Celikoglu et al. 11 performed linear measurements on cephalograms and showed that condylar and ramus height (Co-Go) in UCLP patients was shorter than that in healthy controls. In the present study, no significant difference was found in condylar volume of affected and unaffected sites in UCLP patients compared with healthy controls. Shrestha et al. 10 found no significant difference in condylar volume of affected and unaffected sides between cleft palate patients and healthy controls. Celikoglu et al. 11 reported that the total mandibular volume in UCLP patients was slightly, but not significantly, smaller than that in healthy controls. According to Uçar et al, 12 condylar volume was not significantly different between bilateral CLP patients and healthy controls. Definitions of parameters for condylar measurements in their study were similar to those in the present study. Comparison of condylar parameters between the affected and unaffected sides in UCLP patients in the present study revealed no significant difference in any parameter. Kim et al. 9 evaluated 28 UCLP patients and found no significant difference in condylar height, volume, and mediolateral width between the affected and unaffected sides, which was in agreement with the present findings. Similarly, Veli et al. 14 found no significant difference in condylar height and mediolateral width between the affected and unaffected sides. Wahaj et al. 18 evaluated the panoramic radiographs of CLP patients and reported greater condylar height at the affected side. Celikoglu et al. 6 reported smaller ramus height and ramus and condylar height at the cleft side. Lo et al. 19 evaluated the CT scans of infants with UCLP prior to corrective surgery of the cleft and showed that the volume of the semi-mandible from the symphysis was greater at the cleft side than the non-cleft side. Some studies evaluated vertical asymmetry of the mandible according to the method described by Habets et al. 20 For instance, Paknahad et al, 21 and Celikoglu et al, 6 showed that patients with UCLP had a more asymmetrical mandible than healthy controls in terms of vertical height of the condyle along with ramus. Due to the retrospective design of the present study and evaluations only based on a chart review, the effect of possible confounders on the results could not be analyzed. The healthy control group used in the present study and most relevant previous investigations had a normal growth with class I occlusion. However, since skeletal class III malocclusion is the dominant occlusion in CLP patients, having a control group with class III malocclusion may provide more accurate results. Also, both UCLP and bilateral CLP patients should be compared with healthy controls in future studies to find more comprehensive results regarding the effects of CLP and its unilateral or bilateral type on condylar dimensions and volume. Conclusions According to the present results, only the mediolateral width of the condyle at both sides in UCLP patients was significantly smaller than the values in the right and left sides in the control group. No other significant within-group or inter-group differences were found. Declarations Ethics approval: The study protocol was approved by the ethics committee of the XXXX University (IR.IAU.DENTAL.REC.1400.117). Consent for publication: Consent was obtained from the patient’s legal guardians and patients for publication. Availability of data and material: All data generated or analyzed during this study are included in this article. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable . Authors' contributions: Study concept and design: AT Acquisition of data: FA, ME Analysis and interpretation of data: AT, SM Drafting of the manuscript: FA, RM, ME Critical revision of the manuscript for important intellectual content: AJ Statistical Analysis: RM, BK Administrative, technical, and material support: AJ, RM Acknowledgements: Not applicable. References Dixon MJ, Marazita ML, Beaty TH, Murray JC. 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Hwang HS, Hwang CH, Lee KH, Kang BC. Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop. 2006 Dec 1;130(6):779 – 85. Van Elslande DC, Russett SJ, Major PW, Flores-Mir C. Mandibular asymmetry diagnosis with panoramic imaging. Am J Orthod Dentofacial Orthop. 2008 Aug 1;134(2):183 – 92. Wahaj A, Ahmed I, Erum G. Comparison Of Mandibular Asymmetry Between Cleft Lip Palate And Normal Subjects. J Pak Dent Assoc. 2014;23(2):70–5. Lo LJ, Wong FH, Chen YR, Wong HF. Mandibular dysmorphology in patients with unilateral cleft lip and cleft palate. Chang Gung Med. J. 2002 Aug;25(8):502–8. Habets LL, Bezuur JN, Naeiji M, Hansson TL. The Orthopantomogram®, an aid in diagnosis of temporomandibular joint problems. II. The vertical symmetry. J Oral Rehabil. 1988 Sep;15(5):465–71. Paknahad M, Shahidi S, Bahrampour E, Beladi AS, Khojastepour L. Cone Beam Computed Tomographic Evaluation of Mandibular Asymmetry in Patients with Cleft Lip and Palate. The Cleft palate-craniofacial journal: official publication of the American Cleft Palate-Craniofacial Association. 2018 Aug;55(7):919–24. Additional Declarations There is no duality of interest Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2934380","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":203166887,"identity":"fbe0c2db-ece3-474e-ba4b-570d9f512d17","order_by":0,"name":"Rana Mahjoobi Acsil","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rana","middleName":"Mahjoobi","lastName":"Acsil","suffix":""},{"id":203166888,"identity":"182a6b43-7b5e-4b4a-ba0f-98c48c125e34","order_by":1,"name":"Ahmad Reza Tallaeipoor","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"Reza","lastName":"Tallaeipoor","suffix":""},{"id":203166889,"identity":"386de6e2-3db8-41d0-a64e-36a624e1d80b","order_by":2,"name":"Sandra Mehralizadeh","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Mehralizadeh","suffix":""},{"id":203166890,"identity":"0986f1f3-fc78-40f7-adcd-ade73b7e5f0d","order_by":3,"name":"Mohammad Javad Etesami","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Javad","lastName":"Etesami","suffix":""},{"id":203166891,"identity":"7e3357ff-ed64-460c-94f4-89ddfa3f69a4","order_by":4,"name":"Bita kiaee","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bita","middleName":"","lastName":"kiaee","suffix":""},{"id":203166892,"identity":"cba7a31d-1341-45b9-b9b9-ca3808781d26","order_by":5,"name":"Abdolreza Jamilian","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdolreza","middleName":"","lastName":"Jamilian","suffix":""},{"id":203166893,"identity":"5749953e-b573-4662-9a9b-418dff90a092","order_by":6,"name":"Faezeh Amiri","email":"data:image/png;base64,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","orcid":"","institution":"Tehran University of Medical Sciences, Tehran, Iran","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Faezeh","middleName":"","lastName":"Amiri","suffix":""}],"badges":[],"createdAt":"2023-05-14 18:35:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2934380/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2934380/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":38557433,"identity":"ec97db38-e7ac-4dd4-80a8-fd12a337d410","added_by":"auto","created_at":"2023-06-14 18:12:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":595638,"visible":true,"origin":"","legend":"\u003cp\u003eMeasuring the (A) mediolateral dimension of the condyle; (B) anteroposterior dimension of the condyle; (C) condylar length\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2934380/v1/d1d8efbf64e7cb89cb75e5df.jpeg"},{"id":38557432,"identity":"3f1e5e44-393a-4a74-a032-5c4cadacfa48","added_by":"auto","created_at":"2023-06-14 18:12:55","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":234862,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Manual creation of bubbles at different points of the condyle to determine its primary contour; (B) determination of contour and final volume of the condyle by the software\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2934380/v1/383b527a57a90a404b93f120.jpeg"},{"id":38557495,"identity":"aa64cde5-0ffa-4d37-a284-5b95c7457ad5","added_by":"auto","created_at":"2023-06-14 18:13:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":487881,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2934380/v1/9c68dbb6-9b16-4f3a-8f93-3ee6be0996a8.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"Effect of cleft lip and palate on mandibular condylar volume and dimensions using cone-beam computed tomography","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCleft lip and palate (CLP) are one of the most common congenital anomalies that occur as the result of genetic and environmental factors. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Its global prevalence rate is 1 per 1000 births. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e CLP patients suffer significant impairments in maxillofacial and dental growth and development, which cause malocclusion and esthetic problems. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In general, the morphology of the craniofacial structures such as the maxilla and mandible in CLP patients is different from that in healthy individuals due to a different growth pattern and the implemented treatments. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Evidence shows that anterior and posterior cross-bites are common in such patients \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and such occlusal interferences especially unilateral posterior cross-bite cause over-function of the muscles at the site, which changes the center of temporomandibular joint (TMJ) growth over time. The reason is that the mandibular condyle is among the most sensitive areas to occlusal changes and interferences. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Loads applied to the TMJ cause bone remodeling and change the thickness and shape of the bony components such as the condyle and glenoid fossa. Such changes increase the risk of asymmetry of the mandible, and subsequent esthetic problems and temporomandibular disorders. \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Auricular pain, masticatory muscle pain, mandibular movement limitation, mouth opening limitation, articular sounds, headache, and orofacial pain are among the signs and symptoms of temporomandibular disorders.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral studies have assessed the dimensions and volume of the condyle in CLP patients. For instance, Kim et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e found no significant difference in condylar volume of the affected and unaffected sides in CLP patients. Shresta et al. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e detected no significant difference in volume of the mandible in CLP patients and healthy controls. However, Celikoglu et al. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e reported smaller mandibular volume in CLP patients than healthy controls, and U\u0026ccedil;ar et al. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e showed smaller condylar volume in bilateral CLP patients compared with the control group.\u003c/p\u003e \u003cp\u003eConsidering the existing controversy in the literature and absence of studies comparing the condylar volume of the affected and unaffected sides in unilateral CLP (UCLP) patients, or with a healthy control group, this study aimed to assess the effect of UCLP on the condylar volume and dimensions in comparison with healthy controls using cone-beam computed tomography (CBCT).\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population:\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted on 18 head and neck, and TMJ CBCT scans of patients taken at the Radiology Department of School of Dentistry, Islamic Azad University, and a private radiology center between 2011 and 2018 with definite diagnosis of UCLP. Eighteen CBCT scans of healthy controls were also selected which had been taken for other indications such as assessment of an impacted tooth or orthodontic treatment. The study protocol was approved by the ethics committee of the university (IR.IAU.DENTAL.REC.1400.117).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria:\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were age between 15\u0026ndash;22 years and having undergone surgical closure of the lip and hard tissue before the age of 3.5 years for UCLP patients.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were history of previous orthodontic treatment, history of orthognathic surgery, history of trauma, systemic diseases and syndromic conditions, history of an articular degenerative disease, and bilateral CLP cases. The patients were selected by targeted sampling.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size:\u003c/h2\u003e \u003cp\u003eThe minimum sample size for condylar volume was calculated to be 18 individuals in each group according to a study by U\u0026ccedil;ar et al, \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e assuming alpha\u0026thinsp;=\u0026thinsp;0.05, beta\u0026thinsp;=\u0026thinsp;0.10, mean standard deviation of condylar volume to be 38.5 mm\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and effect size of 0.85. The sample size for other variables was calculated to be lower than 18.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements:\u003c/h2\u003e \u003cp\u003eAll CBCT scans had been taken with NewTom VGi CBCT scanner (Verona, Italy) with the exposure settings of 110 kVp, 2\u0026ndash;29 mA, and 15 x 15 cm field of view, and Rotograph Evo 3D scanner (Villa Sistemi Medicali, Buccinasco, Italy) with the exposure settings of 88 kVp, 9 mA, and 5.8 x 5.8 cm field of view, with patients in upright position and teeth in maximum intercuspation. The images were then converted to DICOM format by NNT Viewer software version 2.21 (Quantitative Radiology, Verona, Italy). The images were three-dimensionally reconstructed by the ITK-SNAP 3.8.0 software (Paul A. Yushkevich, Guido Gerig, Chapell Hill, North Carolina, USA) and evaluated in coronal, sagittal, and axial sections.\u003c/p\u003e \u003cp\u003eOn the cross-sectional slices of each condyle with 1 mm slice thickness in the axial view, the innermost and outermost points of the condylar head were identified and the distance between them was recorded as the mediolateral width of the condyle in tenth of a millimeter. On the axial view, the most anterior and most posterior points of the condylar head were identified and the distance between them was recorded as the anteroposterior dimension of the condyle at each side. Of different slices in the coronal view, the slice showing the uppermost point of the condyle was selected, and its vertical distance from the condylar plane was recorded as the condylar height. The condylar plane is the inferior limit of the condyle, which is parallel to the horizon and passes through the deepest point of the sigmoid notch. All measurements were made in the ITK-SNAP software by using its ruler feature (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo quantify the condylar volume, part of the condyle superior to the condylar plane was considered. To determine the region of interest, the Snake tool was used to outline the superior, inferior, anterior, posterior, medial, and lateral borders of the condyle on multiplanar images. Following segmentation, bubbles were manually created at different parts of the condyle in the coronal, sagittal, and axial planes to determine its primary contour. Next, a semi-automatic 3D model of the condyle was designed by the software and its volume was quantified in cubic millimeters (mm\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eOne-way ANOVA was applied to compare the UCLP and control groups regarding the condylar volume and dimensions. Paired sample t-test was used to compare the values between the affected and unaffected sides in UCLP patients. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the condylar dimensions and volume in UCLP patients and non-cleft control group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCondylar dimensions and volume in UCLP patients and control group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eLevene's Test for Equality of Variances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c11\" namest=\"c5\"\u003e \u003cp\u003et-test for Equality of Means\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStd. Error Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMediolateral condylar dimension of unaffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.0556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.6855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-3.4488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.6624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.0556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.6855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-3.4488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.6624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMediolateral condylar dimension of\u003c/p\u003e \u003cp\u003eAffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.3333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.7088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-3.7739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.8928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.3333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.7088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-3.7741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.8926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnteroposterior condylar dimension of unaffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.4012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.7654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.8654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.4012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.7671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.8671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnteroposterior condylar dimension of affected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.3444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.5466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.4553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.7664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.3444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.5466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.4572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.7683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCondylar length of unaffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.4333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.1437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.8909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.7575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.4333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.1437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.9144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.7811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCondylar length of affected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.2979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2.4210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.8544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.2979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2.4385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.8719\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCondylar volume of unaffected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-200.9167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e164.0958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-534.3995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e132.5662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-200.9167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e164.0958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-534.4083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e132.5750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCondylar volume of affected side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-207.9611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e168.0648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-549.5099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e133.5877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-207.9611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e168.0648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-549.7491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e133.8269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMediolateral dimension of the condyle:\u003c/h2\u003e \u003cp\u003eUCLP patients had a significantly smaller mediolateral condylar dimension at the affected side compared with the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.002). This parameter in the unaffected condyle of UCLP patients was also significantly smaller than that in the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eAnteroposterior dimension of the condyle:\u003c/h2\u003e \u003cp\u003eThis parameter in the affected side of UCLP patients had no significant difference with the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.533). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.902).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCondylar height:\u003c/h2\u003e \u003cp\u003eIn UCLP patients, this parameter in the affected side had no significant difference with the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.868). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.707).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCondylar volume:\u003c/h2\u003e \u003cp\u003eIn UCLP patients, this parameter in the affected side had no significant difference with the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.224). This parameter in the unaffected condyle of UCLP patients was not significantly different from that in the right and left condyles of the healthy control group (P\u0026thinsp;=\u0026thinsp;0.229).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the comparison of condylar dimensions and volume between the affected and unaffected sides in UCLP patients. As shown, no significant difference existed in the affected and unaffected sides regarding mediolateral condylar dimension (P\u0026thinsp;=\u0026thinsp;0.611), anteroposterior condylar dimension (P\u0026thinsp;=\u0026thinsp;0.618), condylar length (P\u0026thinsp;=\u0026thinsp;0.668), or condylar volume (P\u0026thinsp;=\u0026thinsp;0.691).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of condylar dimensions and volume between the affected and unaffected sides in UCLP patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003ePaired Samples Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c10\" namest=\"c4\"\u003e \u003cp\u003ePaired Differences\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003eStd.\u003c/p\u003e \u003cp\u003eDeviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig. (2-\u003c/p\u003e \u003cp\u003etailed)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediolateral condylar dimension of the affected and unaffected sides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.8197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.6827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.1271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnteroposterior condylar dimension of the affected and unaffected sides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.9739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.3677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondylar length of the affected and unaffected sides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.3056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.9688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.7819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.1708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondylar volume of the affected and unaffected sides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-52.9556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e556.5061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131.1697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-329.6995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e223.7884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the effect of UCLP on the condylar volume and dimensions in comparison with healthy controls using CBCT. Use of CBCT for data collection in the present study was due to its 3D nature and the fact that it can provide valuable information regarding malocclusion and dentoskeletal problems in CLP patients. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Two-dimensional imaging modalities have distortion and magnification errors and cannot provide accurate information in this regard. \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The present results showed that UCLP patients had significantly smaller mediolateral condylar dimension in both the affected and unaffected sides compared with the control group. Veli et al. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e evaluated 15 UCLP patients and found no significant difference in mediolateral width of the condyle and condylar height of the affected and unaffected sides of UCLP patients and healthy controls. Similarly, U\u0026ccedil;ar et al. \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e found no significant difference in mediolateral condylar width of bilateral CLP patients and healthy control group. Their results were different from the present findings which may be due to evaluation of bilateral CLP patients in the latter study or different reference points used for the measurements.\u003c/p\u003e \u003cp\u003eIn the present study, the anteroposterior condylar dimension in the affected and unaffected sides in UCLP patients had no significant difference with the corresponding values in the control group. The difference in condylar height was not significant either, which was in agreement with the findings of Veli et al, \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e who calculated the condylar height from the uppermost point of the condyle to the lowermost point of the mandibular foramen. Celikoglu et al. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e performed linear measurements on cephalograms and showed that condylar and ramus height (Co-Go) in UCLP patients was shorter than that in healthy controls.\u003c/p\u003e \u003cp\u003eIn the present study, no significant difference was found in condylar volume of affected and unaffected sites in UCLP patients compared with healthy controls. Shrestha et al. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e found no significant difference in condylar volume of affected and unaffected sides between cleft palate patients and healthy controls. Celikoglu et al. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e reported that the total mandibular volume in UCLP patients was slightly, but not significantly, smaller than that in healthy controls. According to U\u0026ccedil;ar et al, \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e condylar volume was not significantly different between bilateral CLP patients and healthy controls. Definitions of parameters for condylar measurements in their study were similar to those in the present study.\u003c/p\u003e \u003cp\u003eComparison of condylar parameters between the affected and unaffected sides in UCLP patients in the present study revealed no significant difference in any parameter. Kim et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e evaluated 28 UCLP patients and found no significant difference in condylar height, volume, and mediolateral width between the affected and unaffected sides, which was in agreement with the present findings. Similarly, Veli et al. \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e found no significant difference in condylar height and mediolateral width between the affected and unaffected sides. Wahaj et al. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e evaluated the panoramic radiographs of CLP patients and reported greater condylar height at the affected side. Celikoglu et al. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e reported smaller ramus height and ramus and condylar height at the cleft side. Lo et al. \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e evaluated the CT scans of infants with UCLP prior to corrective surgery of the cleft and showed that the volume of the semi-mandible from the symphysis was greater at the cleft side than the non-cleft side.\u003c/p\u003e \u003cp\u003eSome studies evaluated vertical asymmetry of the mandible according to the method described by Habets et al. \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e For instance, Paknahad et al, \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and Celikoglu et al, \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e showed that patients with UCLP had a more asymmetrical mandible than healthy controls in terms of vertical height of the condyle along with ramus.\u003c/p\u003e \u003cp\u003eDue to the retrospective design of the present study and evaluations only based on a chart review, the effect of possible confounders on the results could not be analyzed. The healthy control group used in the present study and most relevant previous investigations had a normal growth with class I occlusion. However, since skeletal class III malocclusion is the dominant occlusion in CLP patients, having a control group with class III malocclusion may provide more accurate results. Also, both UCLP and bilateral CLP patients should be compared with healthy controls in future studies to find more comprehensive results regarding the effects of CLP and its unilateral or bilateral type on condylar dimensions and volume.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAccording to the present results, only the mediolateral width of the condyle at both sides in UCLP patients was significantly smaller than the values in the right and left sides in the control group. No other significant within-group or inter-group differences were found.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics committee of the XXXX University (IR.IAU.DENTAL.REC.1400.117).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConsent was obtained from the patient\u0026rsquo;s legal guardians and patients for publication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and material:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: AT\u003c/p\u003e\n\u003cp\u003eAcquisition of data: FA, ME\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation of data: AT, SM\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: FA, RM, ME\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript for important intellectual content: AJ\u003c/p\u003e\n\u003cp\u003eStatistical Analysis: RM, BK\u003c/p\u003e\n\u003cp\u003eAdministrative, technical, and material support: AJ, RM\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nature Reviews Genetics. 2011 Mar;12(3):167\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOner DA, Tastan H. Cleft lip and palate: Epidemiology and etiology. Otolaryngol Head Neck Surg. 2020;5(4):1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang C, Yin N, Zheng Y, Song T. Characteristics of maxillary morphology in unilateral cleft lip and palate patients compared to normal subjects and skeletal class III patients. Arch Craniofac Surg. 2015 Sep 1;26(6): e517-23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoğan S, \u0026Ouml;n\u0026ccedil;ağ G, Akın Y. Craniofacial development in children with unilateral cleft lip and palate. Br J Oral Maxillofac Surg. 2006 Feb 1;44(1):28\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetye PR, Evans CA. Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients. Angle Orthod. 2006 Sep;76(5):810\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCelikoglu M, Halicioglu K, Buyuk SK, Sekerci AE, Ucar FI. Condylar and ramal vertical asymmetry in adolescent patients with cleft lip and palate evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2013 Nov;144(5):691\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatsavrias EG. Changes in articular eminence inclination during the craniofacial growth period. Angle orthod. 2002 Jun;72(3):258\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang CL, Wang DH, Yang MC, Hsu WE, Hsu ML. Functional disorders of the temporomandibular joints: Internal derangement of the temporomandibular joint. Kaohsiung J Med Sci. 2018 Apr 1;34(4):223 \u0026ndash; 30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim KS, Son WS, Park SB, Kim SS, Kim YI. Relationship between chin deviation and the position and morphology of the mandible in individuals with a unilateral cleft lip and palate. Korean J Orthod. 2013 Aug;43(4):168\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha A, Takahashi M, Yamaguchi T, Adel M, Furuhata M, Hikita Y, Yoshida H, Nakawaki T, Maki K. Three-dimensional evaluation of mandibular volume in patients with cleft lip and palate during the deciduous dentition period. Angle Orthod. 2020 Jan 14;90(1):85\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCelikoglu M, Ucar FI, Buyuk SK, Celik S, Sekerci AE, Akin M. Evaluation of the mandibular volume and correlating variables in patients affected by unilateral and bilateral cleft lip and palate: a cone-beam computed tomography study. Clin Oral Investig. 2016 Sep;20(7):1741\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eU\u0026ccedil;ar FI, Buyuk SK, Şekerci AE, Celikoglu M. Evaluation of temporomandibular fossa and mandibular condyle in adolescent patients affected by bilateral cleft lip and palate using cone beam computed tomography. Scanning. 2016 Apr 22;38(6):720-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGomes AF, Brasil DM, Silva AI, Freitas DQ, Haiter-Neto F, Groppo FC. Accuracy of ITK-SNAP software for 3D analysis of a non-regular topography structure. Oral Radiol. 2020 Apr;36(2):183\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeli I, Uysal T, Ucar FI, Eruz M, Ozer T. Cone-beam computed tomography assessment of mandibular asymmetry in unilateral cleft lip and palate patients. Korean J Orthod 2011 Dec 1;41(6):431-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchlueter B, Kim KB, Oliver D, Sortiropoulos G. Cone beam computed tomography 3D reconstruction of the mandibular condyle. Angle Orthod. 2008 Sep;78(5):880\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHwang HS, Hwang CH, Lee KH, Kang BC. Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop. 2006 Dec 1;130(6):779 \u0026ndash; 85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Elslande DC, Russett SJ, Major PW, Flores-Mir C. Mandibular asymmetry diagnosis with panoramic imaging. Am J Orthod Dentofacial Orthop. 2008 Aug 1;134(2):183 \u0026ndash; 92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWahaj A, Ahmed I, Erum G. Comparison Of Mandibular Asymmetry Between Cleft Lip Palate And Normal Subjects. J Pak Dent Assoc. 2014;23(2):70\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo LJ, Wong FH, Chen YR, Wong HF. Mandibular dysmorphology in patients with unilateral cleft lip and cleft palate. Chang Gung Med. J. 2002 Aug;25(8):502\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabets LL, Bezuur JN, Naeiji M, Hansson TL. The Orthopantomogram\u0026reg;, an aid in diagnosis of temporomandibular joint problems. II. The vertical symmetry. J Oral Rehabil. 1988 Sep;15(5):465\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaknahad M, Shahidi S, Bahrampour E, Beladi AS, Khojastepour L. Cone Beam Computed Tomographic Evaluation of Mandibular Asymmetry in Patients with Cleft Lip and Palate. The Cleft palate-craniofacial journal: official publication of the American Cleft Palate-Craniofacial Association. 2018 Aug;55(7):919\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bdj-open","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdjopen","sideBox":"Learn more about [BDJ Open](http://www.nature.com/bdjopen/)","snPcode":"41405","submissionUrl":"https://mts-bdjopen.nature.com/cgi-bin/main.plex","title":"BDJ Open","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cleft Lip with or without Cleft Palate, Nonsyndromic, Cone-Beam Computed Tomography, Mandibular Condyle","lastPublishedDoi":"10.21203/rs.3.rs-2934380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2934380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to assess the effect of cleft lip and palate (CLP) on mandibular condylar volume and dimensions using cone-beam computed tomography (CBCT).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis cross-sectional study was conducted on the head and neck, and temporomandibular joint (TMJ) CBCT scans of 18 patients with unilateral CLP (UCLP) and 18 non-cleft controls with class I occlusion. The mediolateral and anteroposterior dimensions and height and volume of the right and left condyles were measured by the ITK-SNAP software. Comparisons were made by one-way ANOVA and paired sample t-test (alpha\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe mediolateral dimension of the condyle of the affected side in UCLP patients was significantly smaller than the right and left condyles in healthy controls (mean difference of 2.33 mm, P\u0026thinsp;=\u0026thinsp;0.002). This value at the unaffected side of UCLP patients was also significantly smaller than the right and left condyles in healthy controls (mean difference of 2.05, P\u0026thinsp;=\u0026thinsp;0.005). Anteroposterior dimension, and condylar height and volume at the affected and unaffected sides of UCLP patients were not significantly different within group, or when compared with healthy controls (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOnly the mediolateral width of the condyle at both sides in UCLP patients was significantly smaller than the values in the right and left condyles of non-cleft controls.\u003c/p\u003e","manuscriptTitle":"Effect of cleft lip and palate on mandibular condylar volume and dimensions using cone-beam computed tomography","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-14 18:12:50","doi":"10.21203/rs.3.rs-2934380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bdj-open","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdjopen","sideBox":"Learn more about [BDJ Open](http://www.nature.com/bdjopen/)","snPcode":"41405","submissionUrl":"https://mts-bdjopen.nature.com/cgi-bin/main.plex","title":"BDJ Open","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6838b8f-4e32-4cb8-a28c-85850fd447b1","owner":[],"postedDate":"June 14th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":21761401,"name":"Health sciences/Health care"},{"id":21761402,"name":"Health sciences/Health care/Dentistry/Occlusion"}],"tags":[],"updatedAt":"2023-06-14T18:12:50+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-14 18:12:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2934380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2934380","identity":"rs-2934380","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}