Nasal Base Research Articles

Long-term stability of soft-tissue changes following maxillary distraction osteogenesis in adult subjects of cleft lip and palate

ObjectiveTo test the hypothesis that there is no long-term stability of soft tissue changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Setting and sampleOral Health Sciences Centre at PGIMER, Chandigarh; 15 consecutively treated adult subjects in the age range of 17–34 years with cleft lip and palate who underwent advancement of maxilla by distraction osteogenesis. Materials and methodsLateral cephalograms recorded prior to distraction, at the end of distraction, 6-months after distraction and at least 2-years after maxillary distraction of 15 subjects (M=8, F=7) in the age range of 17–34 years with complete cleft lip and palate were used for the evaluation of treatment outcome and long-term stability of the soft-tissue changes. ResultsThe soft tissue profile, total soft tissue profile and nasolabial angle were improved significantly after immediate (P<0.001), 6-months (P<0.01) and 2-years (P<0.01) of maxillary distraction. Forward movement of the nasal tip and nasal base were increased significantly (P<0.001). The length and thickness of the upper lip was improved after various time intervals of maxillary distraction osteogenesis (P<0.01). Approximately 25% of the changes following maxillary distraction were relapsed during first 6-months of post-distraction follow-up period. ConclusionsDistraction osteogenesis of the maxilla improved the soft tissue profile by increasing the prominence of nose, moving the upper lip forward and normalizing the nasolabial angle. Approximately 75% of the changes were remained stable at the end of 2-years of follow-up of maxillary distraction osteogenesis.

Nasal Base Modification in Asian Patients

Nasal Base Modification in Asian Patients

顎変形症の標準手術 － Le Fort I 型骨切り術－

Othognathic surgery for jaw deformities are most frequently performed in Japan. Regarding those procedures, Le Fort I osteotomy and anterior maxillary alveolar osteotomy in the maxilla, and sagittal split ramus osteotomy, intraoral vertical ramus osteotomy, anterior mandibular alveolar osteotomy, and genioplasty in the mandibule are selected singly or combined based on cases. Among these orthgnathic surgeries, Le Fort I osteotomy is a typical surgical procedure, as well as sagittal split ramus osteotomy. Although the designing of osteotomy lines in Le Fort I osteotomy is simple, this surgical procedure is apt to be regarded as difficult, due to other risk factors in comparison with mandibular osteotomy, such as difficulty in the repositioning of bone segment, complexity of the maxillary bone structure, bleeding, surgical invasion of the nasal cavity and paranasal sinus, and postoperative changes in the nasal base morphology. However, regarding surgical treatment for jaw deformities, Le Fort I osteotomy is considered to be a surgical procedure which we should master, as well as sagittal split ramus osteotomy.Basically, orthognathic surgeries involve subperiosteal surgical manipulation, and it is simply summarized that Le Fort I osteotomy should also be carefully performed without injuring the periosteum. In order to achieve this, it is necessary to accumulate experience, sufficiently understanding the basic factors to safely perform Le Fort I osteotomy. This manuscript outlines the major points in the surgical procedure of Le Fort I osteotomy.

Current Perspectives in Intra Operative Airway Management in Maxillofacial Trauma

Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy. Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation. Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation. Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.

Ergotrid Flap

Defects of the upper lateral lip can prove difficult for surgical repair, as even minute distortion of adjacent tissue may compromise aesthetic and functional results. Options for reconstruction include primary closure, healing by secondary intention, and local flap transfer. In this article, the authors introduce and review their experience with the ergotrid flap for reconstruction of defects of the upper lateral lip. Twenty patients with the aforementioned defect underwent reconstruction with the ergotrid flap with adequate postoperative follow-up and photographs. All 20 patients underwent successful reconstruction with ideal tissue match. There were no cases complicated by distortion of the nasal base or vermilion border. All patients reported satisfaction with their results and scar camouflage. The ergotrid flap serves as a viable option in defects of the lateral upper lip. Therapeutic, IV.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

ObjectiveThe aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. Material and MethodsFacial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. ResultsFrom the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. ConclusionRME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Prevalence of Occult Nostril Asymmetry in the Oversized Nasal Tip

To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program. We performed a retrospective observational study in a private practice, ambulatory care setting. The photographs of 100 randomly selected patients undergoing rhinoplasty who presented with excessive nasal tip width and no apparent nasal base asymmetry were evaluated for occult nostril asymmetry. Patients varied by ethnicity and sex and ranged in age from 16 to 40 years. We excluded patients with discrete nasal base asymmetry, crooked or twisted noses, caudal septal deviation, columellar tilt, a history of craniofacial trauma, or a history of nasal surgery. Measurements were obtained using a standard photographic analysis program. On the basal view, the median percentage of asymmetry (95% confidence interval) was 4.91% (4.17%-5.66%); on the frontal view, 4.66% (3.68%-5.62%). On the basal view, 73% of noses were at least 2.5% asymmetric; on the frontal view, 67% (McNemar P = .53). On the basal view, 48% of noses were at least 5% asymmetric; on the frontal view, 50% (McNemar P = .74). On the basal view, 11% of noses were at least 10% asymmetric; on the frontal view, 20% (McNemar P = .11). A large percentage of individuals presenting with excessive nasal tip width and no obvious alar size discrepancies have nasal base asymmetry. Moreover, nostril asymmetry is demonstrated from the frontal and basal views with reasonable consistency. In a small subset of study patients, occult nostril asymmetry exceeded 10% of the total nasal base width. We postulate that clinically significant nostril size discrepancies are hidden by excessive tip width, and we speculate that these nostril size discrepancies become more apparent after surgical refinement of the oversized nasal tip, thereby potentially leading to unexpected postoperative cosmetic imperfections and patient dissatisfaction. The apparent frequency of (occult) nostril asymmetry in patients with excessive nasal tip width underscores the importance of nostril size assessment in the preoperative aesthetic analysis. We offer a reliable and convenient method for objective analysis of nasal base symmetry.

Prevalence of Occult Nostril Asymmetry in the Oversized Nasal Tip

Objective To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program. Methods We performed a retrospective o...

Nasolabial Volumetric Symmetry Following SARPE

Surgically-assisted rapid palatal expansion (SARPE) widens the maxilla to correct transverse maxillary deficiencies; however, it also enlarges the nasal base, paranasal and cheek regions.Nasolabialvolume changes associated with SARPE theoretically follows its corresponding bony distraction. If transpalatal distraction is symmetrical, the related soft-tissue changes should also be symmetrical. Most studies quantifying symmetry in nasolabial volume focus on cleft patients rather than on orthognathic patients. The purpose of this study was to assess symmetry in the volumetric expansion of nasolabial soft tissue following SARPE using 3D stereophotogrammetry. Forty-three patients with an average age of twenty-four underwent SARPE by the same surgeon (LRC) between July 2006 and July 2010. Sixteen patients with pre- and postoperative 3D photography were included in this retrospective study. The standardized surgical protocol involved a combination of Le Fort I and paramedian osteotomies with pterygomaxillary separation as well as V-Y closure. Pre- and postoperative (at least six months postop) 3D photographs were captured in repose with 3dMDface™ System—a 3D stereophotogrammetric camera setup with an integrated software program modular system. Pre- and postoperative images of each patient were superimposed with a 3D editing software (3dMDpatient V3.0.1), using bilateral exocanthion as registration reference points. Nasolabial region measured was defined by reproducible surface landmarks. Volume differences of nasolabial soft tissue between the superimposed pre- and postoperative surfaces on both left and right sides were then individually computed by the 3D editing software. Non-parametric statistical analysis was performed. Within each patient's 3D photograph set, left or right volume changes were assigned to either “larger expansion group” or “smaller expansion group” based on the magnitude of expansion. Mann-Whitney U test was used to determine if the volume change of nasolabial soft tissue was significantly symmetrical. The range of volume change of nasolabial soft tissue due to SARPE ranged from +0.15 to +4.49 mm3. The mean volume changes in “larger expansion group” and “smaller expansion group” were 2.29 mm3 (SD 1.06 mm3) and 1.61 mm3 (SD 0.91 mm3), respectively. Mann-Whitney U test demonstrated that the volume change of nasolabial soft tissue was asymmetrical (U=77; P = .028). There was an asymmetrical volumetric expansion of nasolabial soft tissue following SARPE. Asymmetrical expansion of nasolabial soft tissue might be secondary to asymmetrical osteotomies, soft tissue management or palatal distractor placement. 3D stereophotogrammetry is a non-invasive, safe, and sensitive technique for evaluation of subtle surgically-induced facial volume changes.

Three-Dimensional Assessment of Early Surgical Outcome in Repaired Unilateral Cleft Lip and Palate: Part 1. Nasal Changes

To evaluate three-dimensional nasal morphology following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data. Prospective, cross-sectional, controlled study. Glasgow Dental Hospital and School, Faculty of Medicine, Glasgow University. Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional, vision-based capture technique. Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images by a single operator. A set of linear measurements was used to compare cleft and control subjects on right and left sides, adjusting for sex differences. The mean nasal base width and the width of the nostril floor on right and left sides differed significantly between control and unilateral cleft lip and palate groups. The measurements were greater in children with unilateral cleft lip and palate. The differences in the mean nasal height and mean nasal projection between the groups were not statistically significant. Mean columellar lengths were different between the left and right sides in children with unilateral cleft lip and palate. There were significant nasal deformities following the surgical repair of unilateral cleft lip and palate.

The Prevalence of Nose Base Asymmetry in General Population

Objective: 1) Evaluate the prevalence of asymmetry of the nasal base in the general population. 2) Quantify among the individuals who carried nasal base asymmetry how many were aware of the fact. Method: Photos of the nasal base of 43 volunteers chosen randomly were taken using a macro lens. Individuals were classified as carriers or noncarriers of nasal base asymmetry. When any asymmetry was present, the image was shown to the carrier, asking whether they were aware or not of the asymmetry. Results: Forty-three individuals between 13 and 70 years old were photographed (16 male and 27 female). The mean age was 43.11 years. Nineteen (44.19%) individuals showed some asymmetry of the nasal basal view. Of these, only 4 (21.05%) individuals were aware of their deformity. Conclusion: Nasal base asymmetry is a prevalent deformity. Most of the individuals (78.95%) are unaware of it. It can generate controversy if the cause of the deformity was or was not a result of surgery. Nasal base asymmetries should always be photographed.

A 10.46 Mb 12p11.1–12.1 interstitial deletion coincident with a 0.19 Mb NRXN1 deletion detected by array CGH in a girl with scoliosis and autism

We present a 12-year-old girl with de novo karyotype 46,XX,del(12)(p11.1p12.1). Array CGH revealed in addition to a 10.466 Mb interstitial deletion on 12p11.1→12p12.1 a 0.191 Mb deletion on 2p16.3. The girl presented with mild facial dysmorphism consisting of microcephaly, hypertelorism, downslanting palpebral fissures, strabismus, broad nasal base, bulbous nose, short philtrum, micro/retrognathia, irregular tooth arrangement, phalangeal deformity in distal phalanges of hands, 5th finger camptodactyly, brachydactyly in feet, history of joint hypermobility, and scoliosis. She was considered to have mild to moderate mental retardation and ascertained for an autism spectrum disorder(ASD). Short arm of chromosome 12 interstitial deletions are rarely reported whereas point mutations and deletions of NRXN1, which is located on chromosome 2p16.3, are associated with ASDs. In this article we present and discuss the phenotypic consequences of a patient who was affected by deletions of two different chromosomal regions.

Alar Base Reduction: The Boomerang-Shaped Excision

A boomerang-shaped alar base excision is described to narrow the nasal base and correct the excessive alar flare. The boomerang excision combined the external alar wedge resection with an internal vestibular floor excision. The internal excision was inclined 30 to 45 degrees laterally to form the inner limb of the boomerang. The study included 46 patients presenting with wide nasal base and excessive alar flaring. All cases were followed for a mean period of 18 months (range, 8 to 36 months). The laterally oriented vestibular floor excision allowed for maximum preservation of the natural curvature of the alar rim where it meets the nostril floor and upon its closure resulted in a considerable medialization of alar lobule, which significantly reduced the amount of alar flare and the amount of external alar excision needed. This external alar excision measured, on average, 3.8 mm (range, 2 to 8 mm), which is significantly less than that needed when a standard vertical internal excision was used ( P < 0.0001). Such conservative external excisions eliminated the risk of obliterating the natural alar-facial crease, which did not occur in any of our cases. No cases of postoperative bleeding, infection, or vestibular stenosis were encountered. Keloid or hypertrophic scar formation was not encountered; however, dermabrasion of the scars was needed in three (6.5%) cases to eliminate apparent suture track marks. The boomerang alar base excision proved to be a safe and effective technique for narrowing the nasal base and elimination of the excessive flaring and resulted in a natural, well-proportioned nasal base with no obvious scarring.

Un nouveau cas de diagnostic anténatal de dysplasie frontonasale

In a 30-year-old patient, the systematic second trimester fetal ultrasound discovered major facial abnormalities suggesting a frontonasal dysplasia (FND). The fetal karyotype was normal but no additional genetic testing was performed. Fetal MRI found an important hypertelorism and an asymmetric cerebral ventricle, with a partially visualized corpus callosum. After several consultations and interviews, the couple made a formal demand for pregnancy interruption, which was approved. Fetal pathologic examination confirmed the diagnosis of FND with no other major associated malformation. This rare pathology results from a midline facial dysgraphia comprising a hypertelorism, a large nasal base, a large clefted nose tip and, a V-shaped hair implantation on the forehead. It often occurs sporadically, of unknown cause, related to a defect in the embryonic nasal capsule development. Syndromic forms have been described with cerebral lesions and possible intellectual deficiency. Consequently, a long and difficult surgical management is necessary, at the expense of poor aesthetic outcome. Seven cases of prenatally diagnosed FND have been reported in the literature, three of which had 3D ultrasound.

Gore-Tex Nasal Augmentation

Gore-Tex Nasal Augmentation

Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy

Introduction: This study evaluate the soft tissue changes to the upper lip and nose after Le Fort I maxillary posterosuperior rotational movement. Materials and Methods: Twenty Skeletal class III patients, who had undergone bimaxillary surgery with a maxillary Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included in the study. The surgical plan for maxilla was posterosuperior rotational movement, with the rotation center in the anterior nasal spine (ANS) of maxilla. Soft and hard tissue changes were measured by evaluating the lateral cephalograms obtained prior to surgery and at least 6 months after surgery. For cephalometric analysis, four hard tissue landmarks ANS, posterior nasal spine [PNS], A point, U1 tip), and five soft tissue landmarks (pronasale [Pn], subnasale [Sn], A' Point, upper lip [UL], stomion superius [StmS]) were marked. A paired t test, Pearson's correlation analysis and linear regression analysis were used to evaluate the soft and hard tissue changes and assess the correlation. A P value <0.05 was considered significant. Results: The U1 tip moved 2.52±1.54 mm posteriorly in the horizontal plane (P<0.05). Among the soft tissue landmarks, Pn moved 0.97±1.1 mm downward (P<0.05), UL moved 1.98±1.58 mm posteriorly (P<0.05) and 1.18±1.85 mm inferiorly (P<0.05), and StmS moved 1.68±1.48 mm posteriorly (P<0.05) and 1.06±1.29 mm inferiorly (P<0.05). The ratios of horizontal soft tissue movement to the hard tissue were 1:0.47 for the A point and A' point, and 1:0.74 for the U1 tip and UL. Vertically, the movement ratio between the A point and A' point was 1:0.38, between U1 tip and UL was 1:0.83, and between U1 tip and StmS was 1:0.79. Conclusion: Posterosuperior rotational movement of the maxilla in Le Fort I osteotomy results in posterior and inferior movement of UL. In addition, nasolabial angle was increased. Nasal tip and base of the nose showed a tendency to move downward and showed significant horizontal movement. The soft tissue changes in the upper lip and nasal area are believed to be induced by posterior movement at the UL area.

Case Report Molecular characterization of microduplication 22q11.2 in a girl with hypernasal speech

We present a 12-year-old girl with karyotype 46,XX. A comparative genomic hybridization array revealed a 3.172-Mb microduplication on 22q11.2. This chromosome 22q11.2 region microduplication has been described in patients with variable phenotypes; a large majority of them have identical 3-Mb duplications. The girl presented mild mental motor retardation, facial dysmorphism consisting of a long narrow face, widely spaced eyes, downslanting palpebral fissures, broad nasal base, short philtrum, thin upper lip, micro/retrognathia, low set and retroverted ears, microcephaly, high-arched palate, hypoplastic teeth, and hypernasal speech. She had delayed psychomotor development and behavioral problems. Molecular characterization of patients differs greatly among reports and detailed molecular characterization and documentation are needed to better understand the effects of these duplications. This description of the phenotype of a patient with microduplication on 22q11.2 will contribute to the growing knowledge regarding deletions and duplications of the 22q11.2 region; this is important to conclude whether 22q11.2 duplication is a microduplication syndrome or not.

Nasal Base Narrowing

To evaluate the role of creating an alar-based advancement flap in narrowing the nasal base and correcting excessive alar flare. Case series with chart review. This is a retrospective record review study. The study included 35 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined the alar base reduction with alar flare excision by creating a single laterally based alar flap. Any caudal septal deformities and any nasal tip modification procedures were corrected before the nasal base narrowing. The mean follow-up period was 23 months. The mean alar flap narrowing was 6.3 mm, whereas the mean width of sill narrowing was 2.9 mm. This single laterally based advancement alar flap resulted in a more conservative external resection, thus avoiding alar wedge overresection or blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid were encountered, and the external alar wedge excision healed with no apparent scar that was hidden in the depth of the alar-facial crease. The risk of notching of the alar rim at the sill incision is reduced by adopting a 2-layer closure of the vestibular floor. The alar base advancement flap is an effective technique in narrowing both the nasal base and excessive alar flare. It adopts a single skin excision to correct the 2 deformities while commonly feared complications were avoided.

Correction of the Nasal Base in the Flaccidly Paralyzed Face: An Orphaned Problem in Facial Paralysis

Correction of the Nasal Base in the Flaccidly Paralyzed Face: An Orphaned Problem in Facial Paralysis

Age- and sex-related changes in the normal human external nose

The objective of this study was to measure: (1) normal sex-related dimensions of external nose (linear distances, ratios, angles, volume and surface area); and (2) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the external nose were obtained by a non-invasive, computerized digitizer in 519 male and 340 female healthy subjects aged 4–73 years. The subjects were divided into 11 non-overlapping age groups: for children and preadolescent subjects, 2-year spans were used, while larger intervals were used for adolescent and adult subjects. From the landmarks, nasal volume and external surface area; nasal and alar base widths, nasal height, nasal bridge length, philtrum length, nasal tip protrusion, right and left nostril lengths, superior and inferior nostril widths; nasal tip protrusion-to-nasal height, and nasal width-to-nasal height ratios; nasal convexity, alar slope, and nasal tip angles were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. On average, men had larger nasal external volume and area, linear distances and nasal width-to-height ratio than women ( p < 0.01); no sex differences were found for the angles and the nasal tip protrusion-to-nasal height ratio. Age significantly influenced all analyzed measurements ( p < 0.001): nasal volume, area, linear distances increased from childhood to old age, while the nasal tip angle decreased as a function of age. No consistent age related patterns were found for the ratios and the nasal convexity and alar slope angles. Men and women had different age related patterns, with significant sex by age interactions ( p < 0.001). Overall, in most occasions male increments in nasal dimensions were larger than female ones. Data collected in the present investigation could serve as a database for the quantitative description of human nasal morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age and sex based data banks.