S4B-22 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS SIMULTANEOUS RHINOPLASTY IN ORTHOGNATHIC SURGERY IN CLEFT PATIENTS

Abstract

Introduction: Thirty five percent of clef and lip patient need an orthognathic surgery to improve the function and aesthetic structure of the face. Considering the proximity between the nose and the maxilla, when a Lefort I osteotomy is performed, nose structure can change, making it difficult for the surgeon to predict the surgical result. Some reports have described the changes seen in non cleft and lip patients. Cleft and lip patients are often seeking to improve their facial structure aesthetically, most of them require a rhinoplasty in order to achieve that. A detailed and careful planning of the surgery as well as an accurate knowledge of the nasal anatomy in these type of patients allows the surgeon to correct and prevent some of the changes made with the osteotomy. The purpose of this study was to evaluate nasal changes in orthognathic patients with cleft and lip, describe surgical considerations made in order to correct and prevent nasal deformities and analyze the aesthetic outcomes and prevalence over time. Methods: A retrospective study over a 5 years period was perform. Two main groups where identify, (1) patients with maxillo mandibular discrepancies and cleft lip and palate and (2) patients with maxillo mandibular discrepancies with out cleft lip and palate. Clinical photographs and CT Scans where analyzed through time, 1 year, 3 years and 5 years. Patient demographic information, medical record, surgical plan and follow up record were compiled. Results: 220 patients undergoing orthognathic surgery with simultaneous rhinoplasty where analyzed. 82 percent of the patients underwent a Lefort I osteotomy. Of this 82 percent, 40 percent were combined maxillo mandibular osteotomies and 60 percent were only lefort I osetomies. The patients were dived into two groups, 37 patients were cleft lip and palate patients and 63 were not. 38 percent of the lefort I osteotomy patients underwent a maxillar advancement of 5mm or more. During surgery 95 percent of the patients with cleft lip needed to correct base widening, where as in the control group 60 percent of the cases needed it. 1 percent of the patients needed a minor nose correction. All of our patients refer a satisfactory aesthethic and functional result. Conclusion: We present our long term results of simultaneous rhinoplasty with orthognathic surgery, in patients with cleft lip and palate, and in patients with out. We observed that the main anatomic changes in patients with cleft and lip were base widening, lost of tip support and lack of tip projection, surgical modifications and recommendations were made for each group of patients. After analyzing our results we conclude that simultaneous rhinoplasty in orthognathic surgery in cleft and lip patients should be performed obtaining satisfying functional and aesthetic results that endure overtime.