Three-Dimensional Anthropometric Analysis of Racial and Ethnic Differences in Unilateral and Bilateral Cleft Nasal Deformity

Abstract

BACKGROUND: Prior studies have demonstrated variation in nasolabial indices across racial and ethnic groups. Anthropometric data on the racial and ethnic differences in the cleft nasal deformity at the age for definitive rhinoplasty can provide a foundation for operative planning. This study used three-dimensional stereophotogrammetry measurements to provide a comprehensive nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across multiple races and ethnicities. METHODS: A retrospective review of three-dimensional images of patients with UCLP and BCLP captured before orthognathic surgery or definitive cleft rhinoplasty was performed. The patients were separated by self-reported identifiers as Caucasian, Hispanic, or African American. Twelve measurements (millimeters) were collected: dorsum length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width. An equal number of age, sex, race, and ethnicity matched control patients were analyzed. Two-sample t tests were performed (P < 0.05). RESULTS: Total patients included 90 UCLP, 43 BCLP, and 90 controls. UCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width and lesser nasolabial angle than respective controls. Caucasian UCLP alar width (33.66 ± 3.12) and alar base width (33.66 ± 3.51) were significantly greater than matched controls (31.21 ± 2.54; 31.33 ± 2.18). Hispanic UCLP alar width (37.52 ± 3.46) and alar base width (36.77 ± 2.81) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08). African American UCLP alar width (41.63 ± 3.43) and alar base width (41.93 ± 3.78) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97). BCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width than respective controls. Caucasian BCLP alar width (37.66 ± 0.77), alar base width (38.06 ± 0.65), and nostril width (12.54 ± 1.68) were significantly greater than matched controls (31.21 ± 2.54, 31.33 ± 2.18, 10.34 ± 1.01). Hispanic BCLP alar width (38.75 ± 3.79), alar base width (38.73 ± 3.35), and nostril width (13.23 ± 2.13) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08; 11.92 ± 2.13). African American BCLP alar width (40.88 ± 3.92), alar base width (40.56 ± 3.97), and nostril width (13.01 ± 2.07) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97; 14.00 ± 1.45). Across UCLP groups the African American group had significantly less nasal protrusion (17.84 ± 1.38) and columellar height (8.96 ± 0.85) and significantly greater columellar width (9.56 ± 1.58) than Caucasians (20.18 ± 1.93, 10.57 ± 1.45, 8.48 ± 1.07), and Hispanics (21.14 ± 2.12, 10.83 ± 1.96, 8.26 ± 1.51). Caucasian alar width (33.66 ± 3.12), alar base width (33.66 ± 3.51), and affected nostril width (10.80 ± 1.51) were significantly lesser than Hispanics (37.52 ± 3.46, 36.77 ± 2.81, 12.04 ± 2.28) and the same measures in both Caucasians and Hispanics were significantly lesser than African Americans (41.63 ± 3.43, 41.93 ± 3.78, 13.96 ± 2.43). Across BCLP groups, there were no significant difference in measurements. CONCLUSIONS: The UCLP deformity differs between groups in alar width and alar base width. African Americans further differ in nasal protrusion, columellar height, and columellar width. The BCLP deformity does not differ between groups. The findings demonstrate that when correcting alar width, alar base width, tip refinement, and projection racially and ethnically congruent goals should be used to better approximate normal appearance.