Abstract
Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.
Highlights
Management of patients with bilateral cleft lip and palate (BCLP) requires collaboration from infancy to maturity between the multidisciplinary cleft team, patient, and parents [1,2,3]
While various surgical strategies are available for repair of bilateral cleft lip and nasal deformity merit recognition for the achievement of outstanding results, the synchronous correction of the nasal deformity at the time of lip repair has been recognized as a major advance in the management of patients with BCLP [4,5,6,7,8,9,10,11,12,13,14,15,16]
Among the patients with BCLP, we found that nasal tip height ratio was greater (p < 0.05) in those who underwent primary plus intermediate rhinoplasty than in those with primary rhinoplasty only
Summary
Management of patients with bilateral cleft lip and palate (BCLP) requires collaboration from infancy to maturity between the multidisciplinary cleft team, patient, and parents [1,2,3]. In addition to enabling linear and angular measurements along the topographic contour of the nose [28,29,30,31,32,33], 3D photogrammetry offers the ability to evaluate the nasal surface area and perform volumetric analyses. This allows us to assess nasal growth-related data, with no need to expose the patient to ionizing radiation [33,34,35,36,37,38]
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