Objective. To compare the asymmetry displayed by Philippine, Colombian, and Ethiopian unaffected parents of patients with nonsyndromic cleft palate (NSCLP) and a control population. Methods. Facial measurements were compared between unaffected parents of NSCLP patients and those in the control group for three populations from South America, Asia, and Africa by anthropometric and photographic measurements. Fluctuating and directional asymmetries, height and width proportions, were analyzed and compared. Results. Fluctuating asymmetries (ear length, middle line to Zigion perpendicular for left and right sides) and variations in the facial thirds demonstrated statistical significance in the study group of unaffected parents from Colombia and Philippines, while increased interorbital distance was evident in the unaffected Ethiopian parents of NSCLP patients. Conclusions. The facial differences in unaffected parents could indicate an underlying genetic liability. Identification of these differences has relevance in the understanding of the etiology of NSCLP. 1. Introduction Cleft lip with or without cleft palate is major structural birth defect that represents a serious public health problem. The nonsyndromic cleft lip palate (NSCLP) prevalence in Ethiopia is 1.49/1000 [1], in Philippines 1.94/1000 [2], and 1.59/1000 [3] in Colombia. This complex multifactorial disease is characterized by genetic heterogeneity, variable expression, and reduced penetrance. Although some environmental and genetics factors have been associated with the etiology of NSCLP, the phenotype definition and the ethnic influence in this pathology result in inconsistent results [4]. It has been suggested that phenotypic features play a role in the familial transmission patterns of orofacial clefts [5]. Several studies demonstrate that unaffected relatives within NSCLP families have different craniofacial features [6] suggesting that certain heritable aspects of facial form represent either a risk factor for clefts or a subclinical manifestation of this anomaly [7]. Some studies suggested that morphological variations and associated traits may represent cleft microforms or may result from more generalized development disturbances [4]. Suggested phenotype risk factors for oral clefting include midfacial deficiency, thin upper lips; increased lower facial height, interorbital distances, nasal cavity, and upper face width [8]; reduced upper face height [9], rotated mandibular position, orbicularis oris muscle defects [10], hypodontia [11], and nonright handedness [12]; asymmetrical dental
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