Analysis of mandibular trabecular bone by fractal analysis in children born with oral cleft

This study aimed to investigate if the mandibular trabecular bone structure of children and teenagers with cleft lip and/or cleft palate (CL/P) differs from non-cleft children using fractal analysis. Children aged between 5 and 15 years with CL/P (cleft group) and a control group were recruited. Syndromic cases of CL/P and isolated cleft palate (CP) were excluded. To obtain the fractal dimension (FD) of the mandibular bone, regions of interest (ROI) were first delineated within the condyle and body of the mandible on panoramic radiographs. Subsequently, the FD was calculated using the box-counting algorithm on these defined ROIs. The results were adjusted by sex and age in a generalized linear model (GLM) with alpha error tolerance of 5%. A total of 205 patients were included. One hundred patients were allocated into the control group and 105 into the cleft group (37 CL and 68 CLP). The fractal dimension (FD) was statistically higher in the control group compared to the study group for both regions of interest (ROIs) (p < 0.001). In the GLMs, cleft was associated with low FD in the condyle (Beta=-0.132; p < 0.001). In the body of the mandible, cleft was also associated with decreased FD values (Beta=-0.154; p < 0.001). CLP presented decreased FD values in the condyle (Beta=-0.016; p = 0.004). Children with CL/P had lower FD values in the mandible compared to the control children, which may indicate that patients born with CL/P present a less complex bone structure.