Quantitative Effects of Cleft Lip and Nose Adhesion on Nostril and Alveolar Discrepancy

Abstract

BACKGROUND: Although there are considerable data quantifying the effects of nasoalveolar molding on definitive lip repair, less is known about the effect of cleft lip and nose adhesion (CLNA) on the alveolar segments and nostril shape in patients who are unable to undergo craniofacial orthodontics. CLNA approximates the lip segments, resulting in the conversion of a complete cleft lip to an incomplete cleft lip while sparing the tissues and landmarks for eventual definitive lip repair. In resource-constrained environments or situations where patients cannot undergo craniofacial orthodontics, CLNA has been shown to qualitatively improve nostril shape before definitive reconstruction in wide cleft. However, less is known about the effects of CLNA alone on the nostril and alveolar cleft segments dimensions. MATERIALS AND METHODS: After obtaining Institutional Review Board approval, a single-center retrospective review of unilateral cleft lip patients undergoing CLNA was performed. Measurements were taken at the time of CLNA and at formal repair. The following data points were extracted for the cleft and noncleft side: nostril height (NH), nostril width (NW), alveolar height (AH), and alveolar width (AW). Dimensional changes from the time of CLNA and time of formal repair were statistically analyzed using a paired Student’s t test. RESULTS: A total of 1,053 surgical cases were reviewed. Eight patients met criteria for inclusion. Average NH before CLNA was 2.3 mm on the cleft side and 5.6 mm on the noncleft side (P = 0.020). After CLNA, the NH on the cleft versus noncleft side was 4.5 and 5.0 mm, respectively (P = 0.553). Average NW before CLNA was 14.8 mm on the cleft side, compared to 7.3 mm on the noncleft side (P = 0.003). After CLNA, the average NW on the cleft side was 11.2 mm, compared to 7.1 mm on the noncleft side (P = 0.007). CLNA resulted in a significant reduction in NW on the cleft side (P = 0.002). The average AW discrepancy, measured as the gap between alveolar segments, was 9.9 mm before CLNA and significantly decreased to 1.5 mm before definitive repair (P = 0.002). AH discrepancy decreased from 11.4 to 6.5 mm (P = 0.060). CONCLUSION: This study reports quantitative changes with CLNA, a powerful tool for reshaping the nostril and approximating the alveolar segments in cases where nasoalveolar molding is not an option. This study demonstrates that CLNA alone achieves a cleft NH which approaches the noncleft side, improved AH and width discrepancy by closure of the gap between alveolar segments, and significant reduction in NW.