Abstract
For better outcomes of the primary correction of cleft lip nasal deformity, it is important to clarify the specific morphological and biomechanical consequences of major surgical maneuvers during cleft lip nose correction. In this study, a finite element model was established basing on the micro-MRI imaging of an infant specimen with unilateral complete cleft lip deformity. Alar base adduction was simulated as a medially-directed force on the lateral crus (F1); columella straightening was simulated as a laterally-directed force on the medial crus (F2); and nasal tip enhancement was simulated as an anteriorly-directed force on the intermediate crus (F3). The deformation and stress distribution consequent to each force vector or different force combinations were analyzed in details. Our biomechnical analyses suggested that W\\when loaded alone, the three forces generated disparate morphological changes. The combination of different force loadings generated obviously different outcomes. F3 generated the most intensive stress when compared to F1 and F2. When F2 was loaded on top of F1-F3 combination, it further relieved nasal deviation without incurring significant increase in stress. Our simulation suggested that alar base adduction, columella straightening, and nasal tip elevation should all be included in a competent cleft lip nose correction.
Highlights
Cleft lip deformity is one of the most common congenital anomalies in human, with an occurrence of 2/1000 in Asians [1]
Surgical correction focused on three maneuvers, moving the alar base medially, straightening the columella, and buttressing the nasal tip, which were simulated by F1, F2, and F3 respectively
The shape of the nose is decided by its underlying cartilage framework and the cleft nasal deformity is caused by the displacement and hypoplasia of the cartliage
Summary
Cleft lip deformity is one of the most common congenital anomalies in human, with an occurrence of 2/1000 in Asians [1]. Due to the displacement and hypoplasia of the alar cartilage framework in the cleft region, cleft lip nasal deformity is of some typical morphological characteristics, including the deviation of nasal tip and columella, displacement of nasal base, collapse of the alar dome, and discontinuity of the nasal sill (Fig 1A) [2]. Contemporary surgical repair could constantly achieved satisfactory lip morphology, the accompanying nasal deformity persists. A major effort in modern cleft lip repair has been focusing on the nose correction [3]. Cleft lip nasal deformity remains a major challenge to surgeons and cleft management teams
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