Alar Base Width Research Articles

Three-Dimensional Facial Soft Tissue Changes After Orthognathic Surgery in Cleft Patients Using Artificial Intelligence-Assisted Landmark Autodigitization.

The purpose of this study was to investigate three-dimensional facial soft tissue changes after bimaxillary orthognathic surgery (BOGS) in patients with cleft lip and palate. The samples consisted of 34 Korean young adult patients with skeletal class III malocclusion who underwent BOGS for maxillary advancement/posterior impaction and mandibular setback. They were divided into cleft-class III (C-CIII) group (n = 18) and noncleft-class III (NC-CIII) group (n = 16). Three-dimensional computed tomography images were taken 1 month before (T1) and 3 months after (T2) surgery. After 34 hard/soft tissue landmarks were automatically identified using software, the amount and direction of change in landmarks and the amount of change in 16 soft tissue variables during T1-T2 were calculated. Then, statistical analysis was performed. Compared to NC-CIII group, C-CIII group showed more posteriorly-positioned hard/soft tissue landmarks, larger alar width, alar base width and philtrum width, and more obtuse nasal tip angle at both T1 and T2 stages. C-CIII group exhibited higher soft-to-hard tissue movement ratios at the bottom of the nose (ΔSn/ΔANS, 1.08 versus 0.81) and the upper part of the upper lip (ΔPoint A'/ΔPoint A, 1.08 versus 0.91), but a lower ratio at the lower part of the upper lip (ΔLs'/ΔIs, 0.72 versus 1.01) than NC-CIII group. The number of hard-soft tissue landmarks with high correlation (>0.90) was smaller in C-CIII group than in NC-CIII group (2 versus 6). Scar tissues and abnormal muscles in the nose and upper lip might elicit different responses in the nasolabial soft tissues to BOGS between C-CIII and NC-CIII patients.

A Novel Study on Alar Mobility of HAN Female by 3dMD Dynamic Surface Imaging System.

The aim of this study is to conduct a quantitative analysis on alar mobility of HAN females and provided referenced materials for alar dynamic aesthetic. One hundred and fifty healthy HAN females without rhinoplasty, nasal injury, nasal deformity and craniofacial deformity were included in this study. 3dMD surface imaging system was used for anthropometric analysis. All participants were instructed to perform the desired dynamic facial expression from rest to maximum smile without reveling teeth and recorded by 3dMD dynamic surface imaging system simultaneously. Two frames of rest status and alar maximum enlargement were selected for measuring alar width, alar base width and inner-canthal distance. The difference between two status represented alar mobility, which was generated through equation: [Formula: see text]. Alar mobility consisted of alar flaring mobility and alar base mobility. The alar flaring mobility was (9.49 ± 4.90)%, reference range was(1.45, 17.53)% and regression equation between rest and maximum smile was Y = 7.953 + 0.886X (R2 = 0.641, p = 0.000); the alar base mobility was (17.94 ± 10.44)%, reference range was (0.88, 35.00)% and regression equation between rest and maximum smile was Y = 4.481 + 0.966X (R2 = 0.528, p = 0.000. Asian alar anatomy has great distinction from Caucasian, processing conspicuous alar movement and damaging alar aesthetic dynamically. This study novelly defined alar mobility by three-dimensional anthropometric analysis, providing objective references for alar dynamic aesthetic and arousing plastic surgeons' attention on keeping balance of static and dynamic aesthetic in rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-Dimensional Anthropometry for Evaluating Reliability of Worm's Eye View Photographs of Unilateral Cleft Lip Nasal Deformity.

Worm's eye view photograph has been widely used for anthropometric analysis. However, it is difficult to secure objectivity because it cannot be captured at a constant head-up degree. This study aimed to analyze whether anthropometric nasal measurements in worm's eye view differ from the actual values. A total of 40 patients with unilateral cleft lip nasal deformities were included. The 30° and 60° head-tilted two-dimensional (2D) photographs were captured from the three-dimensional (3D) images. The real measurements were obtained from 3D images and 2D measurements were obtained from the captured images. The cleft/non-cleft side ratios of the nostril height, width, and alar base width were compared between 3D and 2D images. There was a significant difference in the nostril height between the 3D and 30° values (3D = 0.82, 30° = 0.92, P < 0.001) but no meaningful difference was noted between the 3D and 60° values (3D = 0.82, 60° = 0.84, P = 0.31). There was no significant difference in the nostril width among the 30°, 60°, and 3D values. A significant difference was found in the alar base width between the 3D values and both the 30° (3D = 0.998, 30° = 1.04, P = 0.026) and 60° (3D = 0.998, 30° = 1.03, P = 0.029) values. This study demonstrates that 2D photographs do not accurately reflect actual values. The nostril height and alar width ratio can be changed depending on the head-up position. The 3D systems are more accurate and less affected by the subject's head position. Therefore, the 3D imaging system is advocated for the anthropometric analysis of unilateral cleft lip nasal deformity.

Primary rhinoplasty in unilateral incomplete cleft lip nose: A 4-year follow up

ObjectiveThe aim of this study was to assess aesthetic result and parents’ satisfaction of primary rhinoplasty in unilateral incomplete cleft lip patients. MethodsThirty-two consecutive unilateral incomplete cleft lip nose patients were operated in the tertiary hospital from 2012 to 2014. Primary rhinoplasty was done following the principle of the modified McComb repair. Nostril height, dome height, alar base width, nostril height to width ratio, dome height to nostril width ratio, nasolabial angle and columella deviation were measured on preoperative and 4-year postoperative photographs. Visual analogue scale (VAS) was assessed for each parent before the surgery and 4-year postoperatively. ResultsThe preoperative and postoperative photographic analysis revealed significant improvement in nostril height ratio and dome height ratio. Nostril height to width ratio and dome height to nostril width ratio significantly increased. Alar base width significantly decreased. The nasolabial and columella deviation angles improved significantly. The mean parent-related satisfactory assessment based on the VAS showed statistically improved scores postoperatively. ConclusionWe believe this technique with minimal dissection could improve symmetry and satisfaction, although every individual surgeon could choose his preferable technique based on the components of correction that he is capable of executing reliably while considering the long-term outcomes.

Impact of the Different Types of Le Fort I Maxillary Surgical Movement on Nasal Width Changes: A Photogrammetric Analysis.

Le Fort I maxillary movements affect nasal width, but nasal width changes with specific movement types have not been formally addressed to date. The purpose of this study was to analyze and compare the changes in nasal width with different maxillary movements. A retrospective study was performed among consecutive patients who underwent bimaxillary orthognathic surgery (n = 138) and who were grouped based on the type of maxillary movement (ie, maxillary advancement with intrusion [MAI], maxillary advancement with extrusion [MAE], and maxillary setback with intrusion [MSI]). Preoperative and 12-month postoperative nasal widths were analyzed photogrammetrically by 2 blinded evaluators. Maxillary advancement with intrusion and MAE presented a significantly (P < 0.05) higher alar base widening than MSI did, with no significant (P > 0.05) differences between MAI and MAE. Maxillary advancement movements (MAI and MAE) showed significantly (P < 0.05) higher alar base widening than maxillary setback movement (MSI). However, no significant (P > 0.05) difference was observed between maxillary intrusion (MAI and MSI) and maxillary extrusion (MAE) movements. This study shows that the nasal width varies distinctly depending on the type of Le Fort I maxillary surgical movement.

Comparative study between fisher anatomical subunit approximation technique and millard rotation- advancement technique in unilateral cleft lip repair

ABSTRACT Introduction: The ideal lip repair is characterized by; the symmetrical shape of nasolabial folds and both alae of the nose with a natural-looking philtrum and Cupid’s bow in both static and dynamic states, in addition to a hidden scar. Objective: to compare between Fisher anatomical subunit approximation technique and Millard rotational advancement technique in unilateral cleft lip repair. Methods: Prospective study for 40 patients presented to Alexandria Main University hospital with unilateral cleft lip deformity between March 2019 and October 2020. Twenty patients with unilateral cleft lip deformity were repaired by Fisher anatomical subunit approximation technique, while the other twenty were repaired by Millard rotational-advancement technique. The postoperative photographs of the patients were captured and processed in computer photogrammetry software through which anthropometric parameters including (lip height, lip width, vermilion height, and alar base width) were compared between the normal side and the repaired side. In this software, each anthropometric parameter length on the normal side is taken as a control with a fixed value of (1) then the same parameter on the repaired side was measured as a ratio of this value to avoid bias. Comparison between both groups for assessment of the quality of cleft lip repair was also done based on Steffensen grading criteria. Results: Comparison between both techniques in unilateral cleft lip repair showed that there was no significant difference between them in the anthropometric measurements. While the comparison between the two groups using Steffensen grading criteria showed that Fisher’s technique surpassed Millard’s technique. Conclusion: We recommend the use of the Fisher anatomical subunit approximation technique in unilateral cleft lip repair for its superior results over the Millard rotational advancement technique.

Effectiveness of the Nasal Creator Device After Cheiloplasty in Patients With Cleft Lip and Palate as Measured by 3D Stereophotogrammetry

Objective: To evaluate nostril morphology of patients with unilateral cleft lip and palate. Methods: Three-dimensional images were taken, from which 5 lines and 8 landmark points were evaluated prior to (T0) and 1 day (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after cheiloplasty. Repeated Measure ANOVA was used to evaluate nostril changes between time periods and paired t-test was used to compare values between the affected and non-affected side at T4. Results: After 6 months post-cheiloplasty (T4), the nostril height and width were not significantly different when compared the affected and non-affected sides. When considered the changes between pre-cheiloplasty (T0) and 6 months post-cheiloplasty (T4), the alar base width was not significantly different. The nostril height and width on the affected side showed the significantly changes; the nostril height increased from T0 (2.46±0.89 mm) to T4 (4.22±1.03 mm), and the nostril width decreased from T0 (9.46±2.57 mm) to T4 (7.34±1.41 mm). On the non-affected side, the nostril height significantly increased from T0 (3.39±0.78 mm) to T4 (4.65±1.07 mm), and the nostril width was not significantly different. Conclusion: Using nasal creator device for 6 months post-cheiloplasty significantly increased the nostril height and decreased the nostril width.

Intranasal splint removal after septal surgery: optimum timing

Objectives Complete cleft lip and palate (CLP) is a common congenital middle‑third facial defect, which has considerable medical, economic, social, and psychological consequences for the affected individuals and their families. Many surgical techniques had evolved for correction, but the displacement of the lower lateral nasal cartilage is considered a challenge for the surgeon. Preoperative naso‑alveolar molding (NAM) aims at alignment of tissues, thus improving the surgical outcome. The aim of the current study was to assess the outcome of the use of NAM as a presurgical orthodontic modality for the treatment of patients with unilateral complete CLP associated with nasal deformity. Patients and methods This prospective controlled study was conducted on 16 randomly selected patients with unilateral complete CLP associated with nasal deformity. They were divided randomly into two equal groups. One group included eight patients who underwent presurgical NAM therapy, and the other one included eight patients who underwent surgical repair only as a control. Results A statistically significant difference was found regarding the hemicolumellar height ratio. Although alar base width values were slightly smaller in presurgical NAM therapy group, no statistically significant difference was found for the alar base width values or the domal angles. Conclusion Presurgical NAM proved superior postsurgical nasal symmetry compared with controls regarding the nostril height. The parents of patients with unilateral complete CLP associated with nasal deformity should be counselled to have presurgical NAM to improve the surgical outcome. Keywords: cleft lip, cleft palate, orthodontics.

Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision

A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Both LLCs were isolated, repositioned, approximated medially, and advanced with a Medpor strut, followed by tip suture technique. To further project and enhance the nasal tip and columella, application of ear cartilage onlay graft was used. As adjunctive procedures, septoplasty or osteotomy was carried out for correction of septal or nasal bone deviations, respectively. Photogrammetric evaluations of patients and statistical analyses were performed. Average age at operation was 23.5 years (range: 18-42 years). Of the 62 patients, 15 underwent dorsal augmentation with silicone implant. Two-layer conchal cartilage onlay grafting was performed to manage tip height. Outcomes in 34 patients were analyzed with pre- and postoperative photography. Nasal tip projection increased, alar base width index decreased, and alar and columellar symmetry significantly improved. No Medpor implant exposure or other adverse outcomes occurred. The proposed technique is effective for correcting secondary unilateral CLND and achieving a satisfying nasal appearance in adults.

Short-term and long-term effects of rapid maxillary expansion on the nasal soft and hard tissue.

To evaluate nasal soft and hard tissue changes immediately post-rapid maxillary expansion (RME) and to assess the stability of these changes using cone beam computed tomography (CBCT). A total of 35 treatment group (TG) patients (18 girls, 17 boys; 9.39 ± 1.4) had a pre-RME CBCT and a post-RME CBCT approximately 66 days after expansion, and 25 patients had a follow-up CBCT 2.84 years later. A total of 28 control group (CG; no RME) patients (16 girls, 12 boys; 8.81 ± 1.6) had an initial CBCT and a CBCT an average of 2.25 years later. Soft and hard tissue nasal landmarks were measured in transverse, sagittal, and coronal planes of space on CBCT scans. Differences within the same group were evaluated by paired t-tests or Wilcoxon signed-rank tests. Long-term comparisons between TG and CG were evaluated by independent-sample t-tests or Wilcoxon rank-sum tests. Immediately post-RME, there were statistically significant mean increases of 1.6 mm of alar base width, 1.77 mm of pyriform height, and 3.57 mm of pyriform width (P < .05). CG showed the significant increases over 2.25 years (P < .001). Compared with CG, the long-term evaluation of TG demonstrated only pyriform height and pyriform width showed a statistically significant difference (P < .01). Although RME produced some significant increase on the nasal soft tissue immediately after expansion, it regressed to the mean of normal growth and development over time. However, long-term evaluation of TG compared with CG showed only pyriform height and pyriform width to be affected by RME.

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

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.

Type of maxillary segment mobilization affects three-dimensional nasal morphology

Surgical mobilization of the maxillary segment affects nasal morphology. This study assessed the impact of the type of maxillary mobilization on the three-dimensional (3D) nasal morphometry. Pre- and postsurgery cone beam computed tomography-derived facial image datasets of consecutive patients who underwent two-jaw orthognathic surgery were reviewed. Using preoperative 3D facial models as the positional reference of the skeletal framework, 12-month postoperative 3D facial models were classified into four types of maxillary mobilizations (advancement [n = 83], setback [n = 24], intrusion [n = 55], and extrusion [n = 52]) and four types of final maxillary positions (anterosuperior [n = 44], anteroinferior [n = 39], posterosuperior [n = 11], and posteroinferior [n = 13]). Six 3D soft tissue nasal morphometric parameters were measured, with excellent intra- and interexaminer reliability scores (ICC>0.897) for all the measurements. The 3D nasal change for each nasal parameter was computed as the difference between postoperative and preoperative measurement values. The intrusion maxillary mobilization resulted in a significantly (all p<0.05) larger 3D nasal change in terms of alar width, alar base width, and nostril angle parameters, and a smaller change in terms of the nasal tip height parameter than the extrusion maxillary mobilization; however, no significant (all p>0.05) difference was observed between advancement and setback maxillary mobilizations. The anterosuperior and posterosuperior maxillary positions had a significantly (all p<0.05) larger 3D nasal change in terms of the alar base width and nostril angle than the anteroinferior and posteroinferior maxillary positions. The type of maxillary mobilization affects the 3D nasal morphometry.

Nostril Surgery: Indications, Surgical Procedures and Outcomes-A Systematic Review of Published Cases.

To achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed. We carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out. Excision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty. Nostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding.

Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.

Three-dimensional assessment of nasal changes after maxillary advancement with impaction using stereophotogrammetry.

ObjectiveTo evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion.MethodsThe subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery.ResultsAlare (Al) and alare curvature (Ac) points had moved vertically and antero-laterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale.ConclusionsNasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

Three-Dimensional Analysis of Bilateral Cleft Lip and Palate Nasal Deformity.

This cross-sectional study utilizes 3-dimensional analysis to assess nasal morphology in patients with bilateral cleft lip and palate (BCLP) compared to controls across the timeline of cleft care. Retrospective comparative cross-sectional study. Tertiary pediatric academic institution. One hundred and twelve patients with BCLP and an equal number of age and sex-matched control participants. Nasolabial angle, nasal length, nasal protrusion, columella length, columella width, nasal tip width, alar width, and alar base width were collected at each time point. The measurements were collected pre-nasoalveolar molding (NAM) therapy, post-NAM therapy, post-primary cleft rhinoplasty, 1 year, 5 years, 10 years, and 15 years of age. Nasolabial angle and nasal tip width were significantly different from controls from pre-NAM through 15 years of age time points. Nasal length was not significantly different at any time point. Alar width and alar base width were significantly different from pre-NAM through 10 years of age time points. Nasal protrusion, columella length, and columella width were significantly different from pre-NAM through 5 years of age time points. This study demonstrates that three-dimensional photogrammetry is effective in assessing the changes in nasal morphology that occur throughout the course of care in patients with BCLP from before cleft lip repair to the completion of nasal growth.

The effect of subspinal Le Fort I osteotomy and alar cinch suture on nasal widening

The aim of this retrospective study was to evaluate the relationships between upper jaw movements and nasal soft-tissue changes in patients who have undergone subspinal Le Fort I osteotomy combined with alar cinch suture.Single and multivariate linear regression analyses were used to examine the relationships between greatest inter-alar width (GAW) and maxillary advancement, maxillary impaction, and rotational movements. The database of our referral hospital was searched for patients who had undergone upper jaw surgery with a subspinal LFI osteotomy to correct dentoskeletal deformities between April 2012 and June 2016.Thirty-eight of the patients (15 men and 23 women) who were identified were eligible for inclusion. The average change in inter-alar width (ΔGAW) was +1.7 ± 1.2 mm. GAW increased by 0.3 mm (p < 0.0001) for each millimetre of maxillary advancement, and increased by 0.5 mm (p < 0.0001) for each millimetre of maxillary impaction. GAW increased by 0.2 mm for each degree of counterclockwise rotation of the occlusal plane (p < 0.0001).An analysis of our data compared with the current literature confirmed that subspinal Le Fort I combined with alar cinch suture reduced alar base widening.

Nasolabial angle and nasal tip elevation changes in profile view following a Le Fort I osteotomy with or without the use of an alar base cinch suture: a long-term cohort study

Cinch sutures attempt to counteract alar base widening but may lead to unintended increases in the nasolabial angle and nasal tip elevation. The aim of this investigation was to assess nasolabial angle changes after maxillary osteotomies with and without alar base cinch sutures in the short and long terms. Seventy-eight patients were assessed, with 51 in the cinch group (38 females, 13 males; age range 16-39 years) and 27 in the no-cinch group (12 females, 15 males; age range 17-27 years). The upper component (nasal tip elevation), lower component (lower lip inclination), and the overall nasolabial angle were measured on preoperative, postoperative, and long-term follow-up lateral cephalometric radiographs. The overall nasolabial angle (P=.006) and its upper component (P < .001) increased significantly in the cinch group immediately postoperatively but resolved by 6 to 12 months for the overall nasolabial angle and by 12+ months (up to 5.7 years) for the upper component. There were no significant changes in the no-cinch group. In the short term, the alar base cinch suture increases nasal tip elevation and the overall nasolabial angle. In the long term, there was no significant difference, suggesting that the initial nasal tip elevation resolves over time and that the cinch suture may have a limited effect on nasal tip elevation in the longer term.

Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip

PurposeTo demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction. MethodsThe surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method. ResultsFinite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up. ConclusionForce balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.

Effectiveness of subspinal Le Fort I osteotomy in preventing postoperative nasal deformation

This study sought to determine the effectiveness of subspinal Le Fort I osteotomy (SLFIO) in preventing nasal deformation, by analyzing changes in the nasal profile on three-dimensional computed tomography (3D-CT) images. The participants were 39 Japanese patients with mandibular prognathism (6 men and 33 women) who underwent bilateral sagittal split ramus osteotomy and Le Fort I osteotomy with maxillary advancement: SLFIO was performed in 20 patients and conventional Le Fort I osteotomy (CLFIO) in 19 patients. All patients underwent modified alar base cinch suture, V-Y closure, and reduction of the piriform aperture. CT data acquired before and 1 year after the surgery were evaluated three-dimensionally with software to determine changes in the nasal profile. Changes in alar width, alar base width, nasal length, and nasofrontal angle were significantly smaller following SLFIO than following CLFIO, although there were no significant differences in nasal projection, nasal tip angle, or nasolabial angle between two procedures. SLFIO for anterior repositioning of the maxilla can prevent undesirable transverse soft tissue changes of the nose.