Nasal Base Research Articles

Application of Polymarker Assistant External Alar Wedge Excision Combined With Internal Vestibular Floor Excision in Nasal Alar Reduction

Background: There are numerous techniques available to modify nasal alar. The combined alar base excision technique can narrow the nasal base and correct excessive alar flare at the same time. Despite its effectiveness, this procedure involves the removal of the skin of the nasal alar and the nasal mucosa, making the operation more challenging and raising the risk of postoperative asymmetry complications. Objectives: The purpose of this study is to develop a method of polymarker to assist the operation design to improve the precision of the operation and to avoid the complications discussed above. Methods: The authors conducted a retrospective review of patients undergoing nasal alar reduction using polymarker assistant external alar wedge excision combined with internal vestibular floor excision by a senior surgeon from January 2021 to April 2023. The postoperative appearance was evaluated in stratification by the patients during revisits using a VAS questionnaire. Results: The nasal alar was reduced with polymarker assistant external alar wedge excision combined with internal vestibular floor excision on 30 female patients ranging from 20 to 45 years of age, 10 of which were performed simultaneously with rib cartilage–related rhinoplasty. In all cases, the nasal alar was reduced without distortion. During the postoperative period, all the effects of the surgery were seen to persist for a lengthy period of time, and the patients were generally satisfied with the results.

Effect of Y-shaped Nasal Columella Made of Autologous Cartilage in Secondary Nasal Deformity after Cleft Lip Surgery.

Due to the diversity and complexity of tissues involved in secondary nasal deformities following unilateral cleft lip, secondary nasal deformity correction surgeries are challenging and often yield unsatisfactory results, posing a difficult problem for plastic surgeons. Autologous cartilage, with its low sculpting difficulty, minimal absorption, and stable tissue compatibility, is considered the optimal material for reconstructing the columella, nasal tip, and alar. This study analyzed the clinical outcomes of using autologous cartilage to create a Y-shaped columella to correct secondary nasal deformities after cleft lip surgery. In this retrospective study, 75 patients with secondary nasal deformity after unilateral cleft lip surgery were treated from January 2018 to December 2023. Appropriate costal cartilage, auricular cartilage, and iliac crest cartilage were fashioned into Y-shaped stents and implanted into the nasal columella of the patients to strengthen the tip cartilage. The free alar cartilage was sutured and fixed with a Y-shaped bracket. The wound healing rate, subjective satisfaction evaluation, and complications were analyzed. The nasal appearance, nasal deformity classification, and objective indices of healthy and affected nasal sides, function, and quality of life were compared before and after the operation. All patients healed well during the first stage without related complications, and the average incision healing time was 5.16 ± 1.37 days. The scores of nasal tip position, nasal tip shape, nostril shape, nasal dorsum shape, and nasal floor shape at 6 months post-operation were significantly lower compared to pre-operation (p < 0.001). The grade of nasal deformity at 6 months post-operation was lower than the pre-operation (p < 0.001). Pre-operation, the nasal base and nasal width of the affected side were higher than those of the healthy side, while the nasal columellar and nostril height were lower (p < 0.001). At 6 months post-operation, the nasal base and nasal width decreased, and the nasal columellar and nostril height increased (p < 0.001), with no significant difference between the two sides (p > 0.05). The nasal obstruction symptom evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) scores at 6 months post-operation were significantly lower than pre-operation, while the rhinoplasty outcome evaluation (ROE) score was higher (p < 0.001). The total patient satisfaction was 97.33% (73/75). Y-shaped nasal columella made of autologous cartilage can effectively correct secondary nasal deformity after cleft lip surgery, improve nasal alar collapse, lengthen nasal columella, elevate nasal end, enhance the quality of life, nasal appearance, and nasal ventilation function of patients, with high satisfaction and few complications.

Lengthening Short Noses in Rhinoplasty.

Objective: Rhinoplasty aims to create a nose in harmony with an ideal face, help patients with specific aesthetic concerns, and improve the nose's function. So, learning all types of deformities and rhinoplasty procedures is essential to solving that particular problem. So, we aimed to point at a neglected nasal deformity to serve as a guide in short nose rhinoplasty. Methods: Hereditary factors usually determine the length of a nose, such as cephalo-caudal patterning. Nowadays, individuals who want a change on their nose neglect whether it suits their face. Therefore, a considerable change may cause a paradox and lead to losing the operated nose and face harmony. As a general rule, it should be remembered that short nose elongation sounds more complicated than reduction rhinoplasty. Indeed, multiple soft tissues, mucosa, and structures exist, and short noses may get fibrotic, thickened, and inflamed skin for various reasons. Results: Dorsal augmentation through autologous cartilage grafts or implants is often used in patients with short noses. This demands a primary focus on lengthening the short nasal base. The simplest method of lengthening the short nose is dorsal onlay or radix implants. Silicone implants with a reported non-negligible tendency of infection are no longer used. Autologous cartilage grafts can be harvested from the septum, auricular cartilage, or rib. In the case of short noses, the surgeon can remove the septum as a graft and increase the nasal dorsum or undertake dorsal augmentation through septal cartilage grafts. Conclusion: Dorsal augmentation through autologous cartilage grafts or implants remains valuable for patients with short noses. Surgeons can achieve the desired length and proportional rotation by employing various methods, such as dorsal onlay or radix implants, septal cartilage grafts, and careful tip rotation. Through skillful execution and a patient-centered approach, surgeons can help patients with short noses achieve improved facial harmony and self-confidence.

Three-Dimensional Changes of Alveolar Ridges and Nasolabial Structures Following a Digital Nasoalveolar Molding Therapy With a Novel Nasal Stent Activation Protocol

Digital orthodontics has been integrated into NasoAlveolar Molding (NAM) therapy to overcome challenges in the conventional NAM method. This study introduced an individualized Digital NAM (iDNAM) and evaluated the changes in the alveolar ridges and nasolabial morphology after iDNAM treatment. Prospective data were collected from 15 infants with complete unilateral cleft lip and palate who underwent iDNAM therapy. An intraoral-and-nasolabial scan was used to create a virtual setup model and plate generation. A total of 2 plates were required under the iDNAM treatment protocol. The first iDNAM plate has a specific interior and exterior design to allow continuous force application with minimal plate adjustment. After an intermediate scan, a nasal stent was meticulously incorporated into the second plate for nasal molding. To activate the nasal stent, a silicone molding extension was used instead of manually adding acrylic. The alveolar cleft gap was significantly reduced by 7.48 ± 2.06 mm. On the cleft side, statistically significant increases occurred in nostril height, columellar length, and nasal base–columellar angle (2.08 ± 0.63 mm, 2.58 ± 0.28 mm, and 22.29 ± 0.88 degrees, respectively). By using 2 serial plates, iDNAM improved the alveolar cleft gap and the nasal morphology in complete unilateral cleft lip and palate. An addition of a nasal extension to the second iDNAM plate presents a challenge as accurate positioning is required for appropriate activation force. The iDNAM plate design and nasal activation protocol reduce the need for chairside adjustment and the number of appointments.

A Novel Approach for Improving Midface Aesthetics: A Pilot Study.

Asian individuals often seek solutions to address midface depression and enhance nasal alar base morphology to achieve Western facial aesthetics. Current treatment options, including injections and invasive procedures, have limited efficacy and safety. To address these challenges, we introduced the "modified A-10 surgery," which integrates the Point A-Koji method, titanium plates, and artificial dermis insertion. The efficacy of the modified A-10 surgery was illustrated using a case study of a 22-year-old woman. Surgical planning was based on dental cone-beam computed tomography data, with lateral cephalometric radiographs used to determine the titanium plate dimensions. The surgery involved customized plate alignment, fixation, and artificial dermis insertion. The modified A-10 surgery substantially improved facial aesthetics and structural parameters. Facial convexity increased from 15.5 degrees to 23.2 degrees, enhancing the 3-dimensionality. The nasolabial angle shifted from 91.9 degrees to 110.2 degrees, achieving the desired mouth projection. Other measurements, such as the E-line to the lower lip and the distance from point A to the subnasal point, contributed to refined aesthetics. The nasal alar base thickness increased by 2.2 mm (19.5%), correcting the depression. The modified A-10 surgery represents a minimally invasive and comprehensive solution for midface depression and nasal alar base enhancement. By combining the Point A-Koji method, titanium plates, and artificial dermis insertion, this surgery successfully achieved improved facial aesthetics and contours. The results validate its potential as a long-term solution, with implications for antiaging interventions and promising avenues for future research.

Craniofacial features and incisor position design of esthetics population after orthodontic treatment.

This study aims to provide craniofacial features and incisor position prediction models among esthetics population after orthodontic treatment. A total of 338 patients with esthetic profiles were selected from 1 055 post-orthodontic adults based on inclusion and exclusion criteria and scored by five dental students. Mean values of cephalometric measurement were demonstrated with gender and sagittal skeletal pattern (ANB) differences assessed by generalized estimating equation. Correlations among age, skeletal, and soft tissue variables in different genders were determined. Multivariate analysis was used to assess the influence of skeletal and soft tissue variables on orthodontic incisor position. Within the esthetic cohort after orthodontic treatment, gender differences existed in cranial and mandibular length, mandibular rotation, protrusion of pogonion, inclination of maxillary incisors, upper lip thickness, lower 1/3 face height, and nose protrusion. However, in class Ⅰ malocclusion, the development of the chin showed no significance, whereas the protrusion of the lower lip significantly differed between genders, with less protrusion in males. In males, the protrusion of lip and chin varied among groups, with thinner basic upper lip thickness of class Ⅱ than class Ⅰ and greater lower lip height of class Ⅲ than class Ⅰ. In females, the protrusion and height of the upper lip and chin varied in groups, with thicker basic upper lip thickness of class Ⅲ than class Ⅰ. Upper lip thickness, female basic upper lip thickness, and female lower lip height were correlated with age. The protrusion of the upper lip was mainly correlated with posterior cranial base, mandibular body length, ANB in male and SNA, ANB, sagittal maxillary length, mandibular rotation, and protrusion of pogonion in female. The protrusion of the lower lip in males was mainly correlated with ramus height, mandibular rotation, protrusion of pogonion in male and ANB, mandibular rotation, and protrusion of pogonion in females. After employing skeletal variables to fit dental parameters, optimal results were achieved in male IMPA (adjusted R2=0.712) and female G Vert-U1 (adjusted R2=0.795). After employing skeletal and soft tissue variables simultaneously, optimal results were achieved in male and female G Vert-U1, which was mainly influenced by the protrusion of the chin and nasal base in males (adjusted R2=0.836) and the protrusion of the nasal base as well as ANB in females (adjusted R2=0.842). This study demonstrated the craniofacial features of esthetics population after orthodontic treatment and revealed the correlation of gender, age, skeleton, and soft tissues to provide reliable prediction models for aesthetic orthodontic incisor position.

Enhanced Transconjunctival Lower Blepharoplasty: A Novel Method for Intraorbital Fat Transposition and Stabilization.

The evolution of lower blepharoplasty has shifted from simply removing of orbital septum fat to smoothing of the lid-cheek junction through fat repositioning. This paper adopts a novel technique to transpose and stabilize intraorbital fat during transconjunctival lower blepharoplasty. The tear trough and nasal alar base were filled to correct the pouch while ensuring the blood supply of the fat flap. Between September 2019 and June 2022, 104 patients aged between 22 and 49 who underwent bilateral fat flap transposition-nasal alar base filling lower blepharoplasty were selected. The surgical results were assessed by non-operative plastic surgeons according to the Hirmand grading system. Moreover, a self-satisfaction survey was conducted and patients were followed up for at least 6months to evaluate any complications and surgical outcomes. A high-frequency ultrasound imaging system was used to assess the degree of filling of the tear trough and nasal alar base. All 104 patients were followed up for at least 6months. The postoperative Hirmand grade was 0 for 96 out of 104 (92.3%) patients. In terms of self-satisfaction assessment, there were 92 out of 104 (88.5%) patients reported satisfaction. Dermatologic ultrasound showed no obvious gaps 6months after surgery. Transconjunctival fat flap transposition combined with nasal alar base filling during lower blepharoplasty has been shown to have a positive postoperative effect and high patient satisfaction. This procedure can preserve the blood supply of the fat flap, reduce the rates of fat absorption and denaturation, and improve facial contour, resulting in a satisfactory repairing effect. 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-Part Analysis for Designing Nasal Alar Reduction Surgery in Asian Patients.

The external nasal alar reduction can be associated with many complications, such as nostril malformation and significant scarring. The authors proposed a 3-part analysis method for the design of nasal alar reduction surgery with the aim of improving nasal alar morphology more precisely. The 3-part analysis was based on the patient's flared nose, wide nasal base, and drooping ala, respectively. We included 20 patients who underwent this surgery between January 2021 and January 2022. The visual analog scale (VAS) and the Stony Brook Scar Evaluation Scale (SBSES) were used to assess postoperative scar outcomes. The preoperative and postoperative ratios of the interalar distance to intercanthal distance and nostril shape were analyzed. Patient-reported satisfaction with the esthetic outcome was also assessed. All operations were successfully completed. There were no postoperative complications, such as wound infection or skin necrosis. Both VAS and SBSES assessment of postoperative scarring suggested keloid hyperplasia at 3 months postoperatively. At 12 months postoperatively, the scarring was insignificant and improved significantly over 3 months postoperatively. The mean ratio of the interalar distance to intercanthal distance decreased significantly from 1.15 preoperatively to 1.01 postoperatively (P<0.05). The shape of the patient's nostrils was also significantly improved after surgery compared with the preoperative period. Patient-reported satisfaction after surgery was high at long-term follow-up. The 3-part analysis to design an external nasal alar reduction procedure can accurately improve the morphology of nasal flaring, excessively wide nasal alar base, and nasal ptosis in Asian patients. IV.

Assessment of the Change in the Nasal Septum and Nasal Profile After Le Fort I With Cone Beam Computed Tomography.

This study aimed to determine the relationship between nasal changes and the amount of advancement, impaction, and downward movement of the maxilla after Le Fort I osteotomy. The study included 48 patients who underwent Le Fort I surgery and had pre- and postoperative cone-beam computed tomography records. Changes in the nasal septum were evaluated by measuring septal deviation angles and volumes. In addition, nasolabial angle and width of nasal and alar base were examined. Groups were determined according to the movement of point A (the deepest point on the curvature of the maxillary alveolar process), using a threshold of 1.5 mm for vertical movements and 4 mm for sagittal movements. This resulted in the comparison of 6 groups of 8 people each. Results are presented as mean and standard deviation or median and range depending on the data distribution. Significance level was accepted as P < 0.05. There were no significant differences for each group on its own septal deviation volume or angle values pre/postoperatively. Groups 3 and 5, which both had at least 1.5 mm of impaction, showed significant changes in both deviation angle and volume between the preoperative and postoperative measurements. Nasolabial angle did not show significant changes between groups. Alar base width and nasal width increase was significantly highest in Group 1, which has more than 4 mm sagittal movement and less than 1.5 mm vertical movement. Le Fort I osteotomy may lead to undesirable changes in the spatial positioning of the nasal septum. The results of this study suggest that maxillary advancement does not significantly impact septal deviation, whereas maxillary impaction increases the amount of deviation. In addition, nasal width and alar base width tended to increase, and the nasolabial angle tended to decrease slightly, regardless of the direction of movement of the maxilla after orthognathic surgery. Surgeons should consider increased nasal septal deviation risks when planning impaction of the maxilla. The soft tissue changes in the nose vary according to different directions and amounts of Le Fort I surgery.

An Innovation Technique in East Asia Rhinoplasty.

To investigate the application and therapeutic efficacy of a novel cartilage framework: the external septa framework in East Asian rhinoplasty. From November 2021 to April 2023, Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University, treated 41 patients with autologous costal cartilage rhinoplasty using an innovation external septal framework. The surgical open approach used an inverted V-shaped trans-columellar incision and marginal incision. The sixth or seventh costal cartilage was harvested to form the nasal columella support grafts (strut), external nasal septal graft, cap grafts, and shield grafts, in which the nasal column support graft and external nasal septal graft are connected in a way of tongue in groove to form a external septum framework to support and lengthen the tip. A cap graft is used to shape the tip of the nose, the rectus abdominis fascia is used to cover the tip of the nose, and the shield grafts are used to augment the inferior lobules. ePTFE was sculpted according to the degree of augment of the nasal dorsum and implanted on the dorsal to augment the nasal dorsum. Clinical outcomes were assessed through standard facial photographs taken during the preoperative and follow-up periods, and a postoperative satisfaction survey was completed with regular follow-up using the rhinoplasty outcome evaluation scale (ROE) and visual analogue scale (VAS). Results of objective and subjective measurements before and after surgery were compared utilizing paired-sample t tests. Values of P < 0.05 were considered significant. Nasal framework's objective evaluation outcomes were assessed by measuring the patients' preoperative and postoperative nasolabial angle, nasal length, and nasal tip projection. (The distance between the pronasale and the alar-cheek junction was calculated as the tip projection.) The comparison of preoperative and postoperative nasolabial angle and nasal length was performed using the paired-sample t test, and the comparison of nasal tip projection was performed using the Wilcoxon signed rank-sum test for the comparison of paired samples. Values of P < 0 .05 were considered significant. A total of 41 patients were treated, including 9 males and 32 females, ranging in age from 17 to 48 years(32.8 ± 1.5 years old), In the study, an average follow-up period of 19.85 ± 4.88 months was observed (range 12-29 months). There was no long-term or short-term complication observed. The aesthetic outcome of all cases such as saddle nose, deviated nasal columella, bilateral asymmetry of the nose, bilateral nasal base depression, and bulbous tip was satisfactory. Patient satisfaction evaluation: The ROE scale was (11.85 ± 2.46) preoperatively and (17.43 ± 2.15) postoperatively. The VAS scores were (4.86 ± 1.60) preoperatively and (8.48 ± 1.25) postoperatively. The difference of ROE scale and VAS scores among the patients was statistically significant (P < 0. 05), and 88.9% of patients were satisfied following those procedures. In terms of nasolabial angle, preoperative and postoperative measurements of 41 patients were (86.11 ± 2.25)° and (98.66 ± 1.90)°, respectively, and the difference of nasolabial angle was statistically significant (P < 0.05); nasal length measurements were 39.43 ± 1.55mm (37.95-43.51mm) preoperatively and 42.17 ± 1.46mm (40.23-45.62mm) postoperatively; in terms of nasal tip projection, preoperative and postoperative measurements of median values were 1.84(1.73,2.01)cm and 2.15(2.02,2.32)cm, respectively; and the difference between preoperative and postoperative values was statistically significant (P < 0.05). The innovative cartilage framework-external septal framework, avoids the dissection of septa and absorption of septal cartilage with compression of ESG, it is easy to be performed, and it is also stable and strong to achieve in good aesthetic result. 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 .

Application of Submucosal Trans-Septal Suturing Technique in a Septal Extension Graft With Porous High-Density Polyethylene and Concurrent Nasal Lateral Osteotomy.

Recently, a submucosal trans-septal suturing (STSS) technique was introduced to obviate the dead space of septum after septal extension graft (SEG) with porous high-density polyethylene (pHDPE). To investigate STSS technique after SEG with pHDPE and concurrent nasal lateral osteotomy (LO). A retrospective study was conducted in 53 patients who underwent a STSS technique after SEG with pHDPE and concurrent LO. The postoperative discomfort (nasal pain and obstruction), the width of the nasal bony base, Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation (ROE), and complications were recorded and assessed. The mean surgical duration of STSS was 862.53±227.73 seconds. The maximal mean score of postoperative nasal pain and nasal obstruction was 2.132±0.921 and 1.868±0.8995, respectively. The values on the width of the nasal bony base and ROE were significantly improved after surgery. There was no significant difference in NOSE values preoperatively versus 6 months postoperatively. An infection was found in 1 patient, a recurrent minor bleeding of septum in another patient, and a symptomatic nasal obstruction in other 2 patients. There was no major bleeding, hematoma, foreign body sensation, septal perforation, and other infection. STSS can eliminate the postoperative dead space of nasal septum with low discomfort and complications, and help to avoid a lateral displacement of osteotomized nasal bony segment (ONBS) in patients undergoing SEG with pHDPE and concurrent LO.

Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair.

Rhinoplasty in patients with previous unilateral cleft lip repair is a surgical challenge due to complex nasal deformities, including a horizontally positioned nasal wing, wide cleft side nostrils, nasal base defects, and a short and deviated nasal columella. To comprehensively address these complexities, we exclusively utilized autologous costal cartilage in rhinoplasty procedures, using various surgical techniques. This study presents a comprehensive case series of 39 patients who had previously undergone unilateral cleft lip surgery but still had nasal deformities. Rhinoplasty using autologous costal cartilage was performed at Cho Ray Hospital, Vietnam. Costal cartilage was partially crushed and then finely cut to shape the dorsal area and raise the nasal base on the cleft side. Partially crushed cartilage was also used to shape shield grafts, cap grafts, and alar batten grafts, whereas sliced cartilage was utilized for septal extension grafts. Evaluation was based on improvements in anthropometric indicators, patient satisfaction using Rhinoplasty Outcome Evaluation (ROE) scale and FACE-Q scores. The average age of patients was 25.13 years. All postoperative anthropometric indicators showed significant improvements. Postsurgery, the total ROE score was three times higher than before surgery (P < 0.001), and the total FACE-Q score was 2.26 times higher (P < 0.001). No significant intraoperative or postoperative complications were observed. This procedure effectively addresses complex nasal deformities in patients with prior unilateral cleft lip repair, emphasizing the value of autologous costal cartilage in rhinoplasty for such individuals.

The Isosceles Nasal Tip-Laser-Assisted Midline Assessment in Rhinoplasty.

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Basic and Informative Photographic Standards for Cleft Lip Patients.

Standardized and reliable medical photographs are crucial for preoperative and postoperative comparisons and academic communication in the medical field. There is limited research on photographic techniques in patients with cleft lip. Deformities of the lip and nose in patients with cleft lip are not only associated with morphological abnormalities but also with abnormalities of muscle function. Considering the morphology and function of the lips and nose in cleft lip patients, the study captured the deformity of cleft lip patients in 6 positions: frontal view, 45 degrees left-right tilted side view, 90 degrees left-right tilted side view, and basal view, and in 5 facial expressions: tightly closed lips, slightly open mouth, smiling, teeth bared, and pout. In 6 different positions and 5 different expressions, we took pictures of lip and nasal deformities covering most of the common deformities in patients with cleft lip, such as white lip scarring, interruption of continuity of vermillion border, lip prolapse, asymmetric corners of the mouth, collapsed ala nasi, loss of the nasal base and deviated nasal septum. This paper suggests a set of effective, easy-to-follow, and precise photographic protocols to assist cleft lip surgeons in capturing suitable and informative, high-quality 2D digital photographs. Level-V.

Correlating Jaw Bone Growth and Nasal Morphology Among Adult Patients With Cleft Lip and Palate: A Retrospective Cephalometric Study.

This retrospective cross-sectional study reviewed adult patients with operated cleft lip and/or palate (CL/P) and normal control, and performed comprehensive craniofacial and nasal morphological analyses based on lateral cephalometric radiographs. Pearson or Spearman correlation coefficient assessed intraclass correlation. Seven hundred fifty-seven operated patients with CL/P, and 165 noncleft normal controls were enrolled. Among the normal and CL/P groups, S-N-A angle registered positive correlations with nasal base prominence (S-N'-Sn, degrees). Upper facial height (N-ANS, mm) had positive correlations with nasal dorsum length (N'-Prn, mm) and nasal bone length (N-Na, mm). Although in patients with bilateral cleft lip and palate, there were moderate negative correlations ( r =-0.541, P <0.05) with soft tissue facial profile angle (FH-N'Pog', degree) and nasolabial angle (Cm-Sn-ULA, degree). Correlation exists between the morphology of jaw bones and external nose among patients with CL/P. Maxillary sagittal insufficiency is associated with concave nasal profile, and maxilla height is associated with nasal length.

3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial.

Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. Randomised clinical trial. Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). Changes in facial and nasolabial morphology. Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

The Aesthetic Evaluation of the Brow-Eye Continuum After Correction of Severe Congenital Ptosis in Children With Extended Frontalis Muscle Advancement Technique.

Severe congenital ptosis is a common ocular deformity in pediatric patients that can significantly impact visual development and aesthetic appearance, leading to negative psychosocial outcomes. The frontalis muscle advancement technique is a well-established surgical treatment for severe congenital ptosis. Aesthetic changes of the brow-eye continuum often plays an important role in ptosis surgery. We conducted a single-center retrospective case series study of patients with severe congenital ptosis who underwent the frontalis muscle advancement technique at the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University between April 2020 and June 2021. The study aimed to evaluate the aesthetic changes of the eyebrow-eyelid continuum after surgery. The main outcome measurements included marginal reflex distance 1, palpebral fissure height, eyebrow position, upper eyelid to lower eyebrow distance, lower eyelid to upper eyebrow distance, and nasal base to lower eyelid distance. The study included 48 patients (66 eyelids), with 30 unilateral and 18 bilateral patients. Our analysis found that eyebrow height decreased by an average of 4.8% postoperatively relative to preoperatively in all patients. The frontalis muscle advancement technique has demonstrated effectiveness in achieving aesthetically pleasing outcomes in children with severe ptosis. It is crucial to pay careful attention to the brow-eye continuum during the correction process, as its harmony can greatly impact the final result.

Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion.

This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.

Retrospective study on primary rhinoplasty for unilateral complete cleft lip nasal deformity.

A retrospective study was conducted on the effect of primary rhinoplasty on infants with unilateral complete cleft lip nasal deformity. Infants with unilateral complete cleft lip in the Department of Cleft Lip and Palate Surgery, College of Stomatology, Xi'an Jiaotong University were selected. All infants underwent cheiloplasty and primary rhinoplasty. We reconstructed the nasal base and corrected the nasal septum and alar deformity at the same time. The nasal splint was worn 1 week after the surgery. The nasal morphology before surgery as well as 1 week and 1 year after surgery were analyzed. Significant differences were found on symmetry ratios including nasal base width, nostril height, alar angle and columella deviation angle between before and after operation (P<0.05). There were statistically significant differences in the symmetry ratio of nostril height and columella deviation angle between 1 year after surgery and 1 week after surgery (P<0.05). Infants with unilateral complete cleft lip nasal deformity can achieve satisfactory nasal morphology by primary rhinoplasty. Despite few cases of recurrence of nasal deformity, the nasal morphology can be well improved and maintained.

Observation of Nasal Morphology in Unilateral Microform Cleft Lip Repaired by a Hidden Skin Incision.

Microform cleft lip is the mildest type of cleft lip without obvious defects of the upper lip. The nose deformities of microform cleft lip include flattened nostril rim, alar base asymmetry, and septal deviation. A hidden skin incision with nasal base muscle reconstruction was introduced in nose deformities of microform cleft lip. To investigate the operative effect, we reviewed 21 patients with microform cleft lip treated with a hidden skin incision with nasal base muscle reconstruction from May 2020 to October 2022. Photogrammetric nasal morphometric measurements were compared preoperatively and six months postoperatively. The proportional value was obtained from the cleft and the noncleft sides, and paired t-test analysis was used to evaluate the surgical outcome. Significant differences were found in all nasal morphologic measurements at 6 months postoperatively compared to preoperatively (p < 0.05). After surgery, the alar base and nostril were narrowed, while the lateral lip height was increased on the affected side. The height of the nostrils on the affected side was increased, and the nasal columella deviation was released. In addition, the ratio of the cleft-to-noncleft nostril area was closer to 1.0 after surgery. The unilateral microform cleft lip nasal deformity can be repaired through a small hidden incision. 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 .