Nasal Symmetry Research Articles

The Stabilization of Lower Lateral Cartilage in Rhinoplasty: A New Control Suture Technique.

Abstract Objective: Reposition of malpositioned lateral crura to normal position in rhinoplasty is important both functionally and aesthetically. The aim of this study is to describe a lateral cruras reposition suture technique for supplying tip symmetry and avoiding crural displacement. Patient and Method: Sixteen primary rhinoplasty cases with malpositioned lateral crura underwent lateral crural control suture (LCCS) were reported. In this technique dissected and released lateral crura were fixed to cheek skin with a suture. Those cases were assessed with FACE-Q rhinology module both aesthetically and functionally. Result: Intraoperative or postoperative lateral crural displacement can be prevented and nasal tip symmetry can be supplied easily with LCCS. Results were satisfactory both functionally and aesthetically. Conclusion: LCCS is a good alternative to correct lateral crural malposition and obtain a tip symmetry.

A Three-Dimensional Study of the Nasolabial Soft Tissue Symmetry in Children With Unilateral Complete Cleft Lip and Palate Using Traditional and Split-Type Nasoalveolar Molding.

Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement. A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients' craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software. After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups. The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.

Rotational Composite Flap Technique for Primary Incomplete Cleft Nose Deformity.

Nasal deformities accompanying unilateral incomplete cleft lip have minor skeletal and soft tissue deficiencies compared with deformities associated with unilateral complete cleft lip. Extended dissection and surgical incisions (often required for nasal deformities in complete cleft lip) are not recommended to address deformities accompanying incomplete cleft lip. The purpose of this study is to describe an innovative method involving a rotational composite flap for nasal repair in patients with unilateral cleft lip. Since 2016, 49 consecutive patients with unilateral incomplete cleft lip have undergone primary anatomical repair of accompanying nasal deformities. The technique involves a skin incision along the marginal and intercartilaginous borders to create a V-shaped composite flap consisting of vestibular skin and alar cartilage. Rotational mobilization of the composite flap creates a triangular raw surface laterally, which is closed by advancement of the vestibular skin. This innovative method, which is based on the use of a rotational composite vestibular flap, achieves proper symmetry of the repaired nose. The herein described composite flap rhinoplasty is a good surgical option, which provides a good overall nasal symmetry in patients with nasal deformities accompanying unilateral incomplete cleft lip.

Applied Online Crowdsourcing in Plastic and Reconstructive Surgery: A Comparison of Aesthetic Outcomes in Unilateral Cleft Lip Repair Techniques.

Aesthetic outcomes of unilateral cleft lip repairs have important psychosocial implications for patients who are heavily influenced by social perceptions. Online crowdsourcing offers the unique potential to efficiently recruit large numbers of laypeople to assess public perception. The aim of this study was to use the online crowdsourcing platform Mechanical Turk to compare the postoperative outcomes of Fisher, Millard, and Mohler cleft lip repair techniques. Two hundred fifty-four participants were recruited through Mechanical Turk to evaluate 29 cropped and deidentified photographs of children, 8 photographs were controls without cleft lips and 21 were children with unilateral cleft lips who had undergone Fisher, Millard, or Mohler repairs (7 in each group). Respondents were asked whether a scar was present, whether they would be personally satisfied with the surgical result and used a Likert scale from 1 to 5 to rate overall appearance, scar severity, and nasal symmetry. Fewer respondents reported that a scar was present when assessing postoperative photographs of Fisher repairs (70.3 ± 8.6%) compared with Millard (92.0 ± 1.5%) or Mohler (88.8 ± 3.1%) repairs. Average rating of scar severity was also lower for Fisher (1.9) compared with Millard (2.6) or Mohler (2.6) repairs. Average ratings of nose symmetry, general appearance, and satisfaction with operative result were not statistically significantly different between the repair groups. This study demonstrates the potential of online crowdsourcing to assess public perception of plastic surgery outcomes. The Mechanical Turk platform offers a reduction in selection bias, ease of study design, and enhanced efficiency of large-scale participant recruitment. Results indicate that the Fisher repair led to the most favored aesthetic outcomes compared with the Millard and Mohler techniques, particularly with regard to scar severity. Crowdsourcing is a powerful tool to assess layperson perception of plastic surgery outcomes and can be used to better guide surgical decision-making.

Effect of Nasoalveolar Molding on Nasal Symmetry in Patients With Cleft Lip and Palate: A Systematic Review

Effect of Nasoalveolar Molding on Nasal Symmetry in Patients With Cleft Lip and Palate: A Systematic Review

EFFECT OF CAD/CAM NASOALVEOLAR MOLDING APPLIANCE ON CORRECTION OF THE NASAL DEFORMITY IN COMPLETE BILATERAL CLEFT LIP AND PALATE

Introduction: Cleft lip and palate (CLP) affects about 1.5 per 1000 live births (250,000 new cases per year) worldwide. They can be either unilateral or bilateral, complete or incomplete. The bilateral cleft lip and palate (BCLP) deformity typically arises with a protrusive premaxilla. The nasal deformity includes deficient columella, with flared lateral alar cartilages which usually require additional surgeries to improve the nasal symmetry. NasoAlveolar Moulding (NAM) technique, aims to align the alveolus, lip, and nose properly; reduce the severity of the nasal deformity, and lengthen the columella without surgery. Objectives: The study aims to quantify the effect of NAM therapy, fabricated by CAD/CAM additive manufacturing, in the improvement of nasolabial deformity in terms of bialar width, columellar length and width in infants with complete BCLP. Materials and methods: Ten infants with non-syndromic BCLP (age < 1 month) were selected. Impressions were obtained. The casts obtained from the impressions were scanned using a 3D laser scanner. Designing and 3D printing of the appliances were completed. The appliances were inserted and retained using surgical tapes. Nasal stents were incorporated 60 days after the start of the treatment. Nasal measurements were obtained before treatment and at the end of treatment (after four months). Results:Data was collected and statistically analyzed. After NAM therapy, there was a statistically significant increase in columellar length and a statistically significant decrease in both columellar width and bialar width. Conclusions: CAD/CAM PNAM therapy has proved its effectiveness in BCLP by showing an improvement in the columellar and bialar presurgical presentation. CAD/CAM PNAM therapy should be considered a routine procedure in the treatment protocol for BCLP.

Secondary Unilateral Cleft Rhinoplasty Using Natural Curvature of Rib Cartilage as Alar Rim Graft: A Three-Dimensional Evaluation of Long-Term Results

Since 2012, the senior author has incorporated the natural curvature of rib cartilage as an alar rim graft in addition to the diced cartilage technique for unilateral cleft rhinoplasty. The aim of this study is to describe this modification and evaluate its long-term results regarding nasal symmetry using three-dimensional stereophotogrammetric assessment (3dMDface system). From 2012 to 2018, 47 consecutive patients that underwent secondary unilateral cleft rhinoplasty were reviewed retrospectively. Sixteen patients with both preoperative and postoperative three-dimensional photographs taken at least 6 months after the operation were included. SimPlant O&O software was used to measure parameters on three-dimensional photographs: nostril heights, nostril widths, nasal dorsum heights, alare width, nostril areas, overlapping nostril area, nasal tip protrusion, nasal length, and nasal height before and after surgery. The ratios between cleft and noncleft sides were calculated. In addition, the overlapping nostril area ratio, tip protrusion-width index, and nasal index were compared before and after surgery. The preoperative nostril height ratio (0.79), nostril width ratio (1.24), and nasal dome height ratio (0.84) between cleft and noncleft sides were significantly improved after surgery to 0.93, 1.06, and 0.97, respectively. The preoperative overlapping nostril area ratio (72.33 percent), nasal tip protrusion-width index (0.48), and nasal index (0.81) also showed significant improvement postoperatively to 83.91 percent, 0.57, and 0.74, respectively. This preliminary study supports the use of natural curvature of rib cartilage as alar rim graft in secondary unilateral cleft rhinoplasty, with long-term improvement regarding nasal symmetry and nasal profile. Therapeutic, IV.

Educational intervention for the evaluation of nasal symmetry in cleft lip and palate operated patients.

Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Quasi-experimental study. In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.

Dynamic changes in nasal symmetry after presurgical nasoalveolar molding in infants with complete unilateral cleft lip and palate.

Background:Presurgical nasoalveolar molding (PNAM) technique gave a new perspective to presurgical infant orthopedics. Nasal reconstruction presents a challenge for the plastic surgeons in case of patients with unilateral cleft lip and palate (UCLP). PNAM facilitates the reshaping of the nasal cartilage and molding of maxillary arch preoperatively. This therapy not only aids the surgical repair of lip but also enhances the overall postsurgical results with negligible postoperative scar.Aim:The aim of the study was to analyze nasal changes before and after PNAM in patients with complete UCLP.Materials and Methods:This was a retrospective review of 22 ULCP patients who underwent PNAM before lip surgeries. A series of standard basilar view photographs in 1:1 ratio were taken, and linear measurements were done directly on the photographs.Results:After PNAM therapy, there was highly significant increase in the nostril height, nostril dome height, and columella length (P < 0.001*) and highly significant reduction in the nostril width and nasal basal width (P < 0.001*).Conclusion:Significant improvement in the nasal symmetry was found after PNAM therapy in patients with complete UCLP.

Effect of a novel rotating advancing method on reconstruction of nasal lip symmetry

Objective To introduce the application of muscle reconstruction torque balance theory in the new rotating advancement method, and to evaluate the postoperative effect of this method on the nasal lip symmetry of patients with unilateral cleft lip. Methods A total of 62 patients with unilateral cleft lip were treated with two-dimensional radiography of posterior anterior position and mandibular chin position before, immediately and one-year follow-up. Five indexes representing the symmetry of lip and nose were measured by photoshop software. T test was used to compare the measurement results of each angle or distance index at different times. P<0.05 showed that there was significant difference between the two groups. Results All the patients who were treated with the technique described in this study obtained satisfactory lip and nasal symmetry immediately and one-year follow-up. Conclusions The new theory of oral muscle strength balance is a new breakthrough on the basis of the application of muscle reconstruction. It is suitable for the primary repairment of unilateral lip, and good results have been obtained. Key words: Cleft lip; Orthopedic procedures; Muscle reconstruction; Muscle strength balance; Torque; New rotating advancement method

Pyriform Costal Cartilage Graft Improves Cleft-Side Alar Asymmetry in Secondary Cleft Rhinoplasty.

The asymmetry of a retrusive cleft-side ala positioned posterior, lateral, and inferior relative to the noncleft ala is exacerbated by ipsilateral deficiency of the pyriform aperture. We describe use of pyriform costal cartilage grafts for enhanced structural foundation and alar symmetry in secondary cleft rhinoplasty. Retrospective case series. All pyriform aperture paranasal augmentation secondary cleft rhinoplasty cases performed between May 2013 and February 2018 were included. Clinical photos were analyzed, and these results are provided in addition to a detailed description of the augmentation technique. Twelve total cleft patients, 10 (83.3%) unilateral cleft lip and palate, 1 (8.3%) unilateral cleft lip, and 1 cleft palate (8.3%) were included. Age averaged 18.6 ± 6.0 years with 3 (25.0%) males and 9 (75.0%) females. Costal cartilage grafting to the pyriform aperture through the gingivobuccal sulcus was used to reposition the alar base and nasal sill to a more anatomic anterior position, thereby enhancing symmetry in secondary cleft rhinoplasty. Average rib graft donor site incision was 2.5 cm. Follow-up ranged from 3.2 to 48.2 months, average 15.3 ± 14.4 months. No complications related to the pyriform cartilage graft were observed, other than one minor intraoperative breach of parietal pleura. We observed improvement in the anatomic contour of the cleft-side ala with costal cartilage grafting to the pyriform rim. This resulted in improved cleft-side alar form and thus overall alar symmetry. These results were obtained consistently, without significant complications. This technique is safe and provides a powerful tool to reposition the ala in secondary cleft rhinoplasty. Further studies will quantify the enhancement in nasal base symmetry.

Early Cleft Repair Versus Nasoalveolar Molding: Comparing Preoperative Severity and Postoperative Results Utilizing a Computer Engineered AI System

BACKGROUND: Early cleft lip repair (ECLR) can be performed safely and effectively. One persistent question is whether ECLR may be offered to wide unilateral complete clefts who historically would have received nasoalveolar molding (NAM). This study aims to compare the preoperative cleft severity of ECLR patients to those who underwent NAM pretreatment and compare postoperative outcomes. METHODS: Unilateral CL patients (January 1, 2005, to September 11, 2018) were retrospectively reviewed and divided into 2 groups: ECLR (age <3 months) and presurgical NAM with CL repair (age 3–6 months). Pretreatment CL severity was assessed using an AI computer engineered system that calculated cleft width ratios (CWRs, pretreatment cleft width divided by commissure width). For further analysis, a second subset of wide complete cleft lip patients undergoing ECLR (excluding incomplete clefts) was created to compare to the NAM group. RESULTS: Seventy-four ECLR patients and 25 NAM patients (average age at repair 32.24 and 117.56 days, respectively) met inclusion criteria. Mean CWR was 0.456 for ECLR patients and 0.501 for NAM patients (P = 0.165). The ECLR subgroup considering only patients with complete cleft lips had a mean CWR of 0.520, suggesting that this group had more severe clefts. The ECLR subgroup’s average lip length, frontal nasal breadth, commissure length, nostril breadth, nostril width, and nasal angle symmetry ratios were compared to the NAM group’s postoperatively. The average lip length, frontal nasal breadth, and commissure length symmetry ratios for the ECLR subgroup of 27 complete clefts were 0.88, 1.05, and 0.92, respectively, compared to 0.93, 1.08, and 0.89 for the NAM group (P = 0.181, P = 0.526, P = 0.378). The average nostril breadth, nostril width, and nasal angle ratios among the ECLR subgroup were 1.09, 1.17, and 1.12, respectively, compared to 1.12, 1.19, and 1.14 in the NAM group (P = 0.480, P = 0.613, P = 0.640). CONCLUSION: ECLR provides patients with severe cleft lips an alternative option to NAM with at least equivalent results. With increased experience, long-term data, and increased awareness, we feel that ECLR has the potential to be a paradigm shift in the treatment of the cleft lip/nasal deformity.

Evaluation of Corrective Rhinoplasty in Cleft Lip Nasal Deformity

Background: Cleft lip nasal deformities are challenging problems in all aspects and there are debates about timing, approaches, techniques as well as types of the used grafts. Objective: Evaluation of the results of corrective rhinoplasty in post cleft lip nasal deformity at Al-Azhar University Hospitals (Al-Hussien and Said Galal Hospitals). Patients and Methods: This is a prospective clinical study which included thirty patients having post cleft lip nasal deformity whom underwent corrective rhinoplasty for cleft lip nasal deformity. These patients were managed at AlAzhar University Hospitals (Al-Hussien and Said Galal Hospitals) during the period from May 2017 to January 2019. Results: The vast majority of the operated upon patients had an obvious degree of satisfaction after 6 months to 12 months of postoperative follow up. Conclusion: Autologous cartilaginous grafts are the most suitable type of nasal grafts, and costal cartilage graft is the most superior between them. Further studies are needed to justify if primary rhinoplasty is beneficial or it disturbs the nasal symmetry and leave scared tissues for a potential future intervention.

Nasolabial Aesthetics Following Cleft Repair: An Objective Evaluation of Subjective Assessment.

Assess the weight and contribution of each of the parameters of the Asher-McDade Scale to overall subjective assessment of nasolabial aesthetics following cleft lip repair. Retrospective cohort evaluation. Cleft and craniofacial center. Forty-one patients who underwent unilateral cleft lip repair. Unilateral cleft lip repair. Nasolabial rating using the Asher-McDade scale and overall subjective assessment of nasolabial aesthetics using a rank score following unilateral cleft lip repair. Strong interrater reliability was observed between the 3 raters. Significant association was determined on bivariate analysis between nasal form score (β = 27.06; P < .001), nasal symmetry score (β = 26.41; P < .001), nasal profile score (β = 28.75; P < .001), vermilion border score (β = 13.40; P = .012), and the ranking score. Adjusted β coefficients obtained from multivariate regression analysis were used to develop a modified nasolabial appearance score (over 5), that is, weighted for each of the 4 parameters: nasal form (over 8, adjusted β = 14.33), nasal symmetry (over 5, adjusted β = 7.96), nasal profile (over 5, adjusted β = 9.44), and vermilion (over 2, adjusted β = 3.31). Regression analysis between our modified nasolabial appearance score and patient ranking score demonstrated superior goodness of fit when compared to the Asher-McDade overall nasolabial appearance score (R2 = .80; P < .001 vs R2 = .69; P < .001). The parameters evaluated in the Asher-McDade scale have different weights and contribute differently to overall subjective assessment of nasolabial aesthetic outcomes following cleft lip repair. Adjusting for their weights results in a modified score that demonstrates superior correlation with overall subjective assessment of nasolabial aesthetic outcomes.

Comparison of outcome of Modified Millard’s Incision and Delaire’s Functional Method in Primary Repair of Unilateral Cleft Lip.

Objective: To contrast results of two surgical methods for correction of Unilateral Cleft lip. Methodology: Prospective study was conducted from October 2018 to October 2019 after ethical approval from institute ethical board. Data was collected than arranged over Microsoft Excel 2007.Variables then formed or for further statistical results data was entered in SPSS version 15.0. Variables were assessed by using. . Standard Deviation and Mean was calculated and presented for quantitative data like age and weight. Frequency (percentages) were calculated and presented for qualitative data such as gender and outome variables. Post stratification statistical chi square test was used to see effect modification. P value ≤ 0.05 was considerable. Results: Out of 100% (n=66) unilateral cleft lip patients, 50% (n=33) patients each were operated with Modified Millard’s incision and Delaire’s functional method respectively. Various parameters were analyzed—white roll match, cupid bow, lip length and alar dome demonstrated favorable measurements in Millard’s group and the vermilion match, scar appearance, nostril symmetry and alar base was better in Delaire’s methods. All the differences in these parameters were not statistically significant, except lip length (p=0.023). Conclusion: Overall clinical outcomes like vermilion match, white roll, and cupid bow appearance was similarly effective in both techniques. Outcome related to lip length was considerable in incision by Millard’s technique. Similarly nasal symmetry was better in Delaire’s functional method. This leads to significance of one method over other. Keywords: Primary Repair, Modified Millard’s, Delaire’s Functional Method Unilateral Cleft Lip. DOI : 10.7176/JMPB/54-04 Publication date : April 30 th 2019

Nasolabial outcomes in a nationwide study of orofacial cleft in New Zealand.

To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies. Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n=279) and eight-ten (n=191) years of age. Cropped images were assessed using the Asher-McDade (AM) and a 100mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra- and inter-rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation. The AM intra-rater reliability was moderate/substantial, whilst inter-rater reliability was fair. The VAS intra-rater correlations were high, and inter-rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP. The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability.

Esthetic evaluation of early rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding

Background: The aesthetic outcome of primary rhinoplasty with complete unilateral cleft lip repair is a challenging due to nasal deformities, tissue deficiencies and alveolar ridge displacement. The aim of this study is aesthetic evaluation of primary rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding (NAM). Patient and methods: The study was applied on 30 patients with complete unilateral cleft lip, mean age at presentation was 89.17± 73.02 days (range 15-260 days). Presurgical nasoalveolar molding (PNAM) was done for all patients with mean duration of molding 78.48± 5.635 days (range 66-87 days). Measurements of nose and alveolar defect were taken by caliper before application of the device and after application of the device and after one month of operation and compared with each other’s. All patients were subjected to lip repair with Millard technique with primary closed rhinoplasty. Primary rhinoplasty with cleft lip repair becomes easier since NAM diminishes the tension over the soft tissues and reduces severity of deformity in the lower lateral alar cartilages. Postoperative nasal stent has a great role in improve the esthetic outcome of primary rhinoplasty. Results: There were significant improvement of nasal symmetry and reduction of alveolar gap width (AGW) after use of NAM. Conclusion: This study suggests that PNAM within 15 days post-delivery is effective at reducing alveolar gap width, alignment of cleft alveolar segments and improvement of nasal symmetry as long as the parents cooperate in placing and maintaining the NAM device in the newborn’s mouth and nose.

Esthetic evaluation of early rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding

Background: The aesthetic outcome of primary rhinoplasty with complete unilateral cleft lip repair is a challenging due to nasal deformities, tissue deficiencies and alveolar ridge displacement. The aim of this study is aesthetic evaluation of primary rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding (NAM). Patient and methods: The study was applied on 30 patients with complete unilateral cleft lip, mean age at presentation was 89.17± 73.02 days (range 15-260 days). Presurgical nasoalveolar molding (PNAM) was done for all patients with mean duration of molding 78.48± 5.635 days (range 66-87 days). Measurements of nose and alveolar defect were taken by caliper before application of the device and after application of the device and after one month of operation and compared with each other’s. All patients were subjected to lip repair with Millard technique with primary closed rhinoplasty. Primary rhinoplasty with cleft lip repair becomes easier since NAM diminishes the tension over the soft tissues and reduces severity of deformity in the lower lateral alar cartilages. Postoperative nasal stent has a great role in improve the esthetic outcome of primary rhinoplasty. Results: There were significant improvement of nasal symmetry and reduction of alveolar gap width (AGW) after use of NAM. Conclusion: This study suggests that PNAM within 15 days post-delivery is effective at reducing alveolar gap width, alignment of cleft alveolar segments and improvement of nasal symmetry as long as the parents cooperate in placing and maintaining the NAM device in the newborn’s mouth and nose.

Impact of nasalis muscle repair in unilateral cleft lip patients

BackgroundAlthough the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry. Patients and methodsA controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft. Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles measurement. ResultsGroup 2B patients showed significantly better shape and symmetry of nasal tip, size and symmetry of nostrils and size, form and lateral displacement of the ala. Objective evaluation showed that group 2B had the closest results to the non-cleft side, with statistically significant difference, when compared to other groups. ConclusionDissection and repair of both origin and insertion of nasalis muscle produced a nasal width, columellar height, and nasal tip projection close to the normal population of the same age.

Facilitating CAD/CAM nasoalveolar molding therapy with a novel click-in system for nasal stents ensuring a quick and user-friendly chairside nasal stent exchange

Nasoalveolar molding (NAM) aims to improve nasal symmetry with a nasal stent in cleft lip and palate (CLP) patients. When plates have to be exchanged because of dentoalveolar growth or cleft reduction, the nasal stent has to be mounted onto a new plate. This procedure elongates visiting hours for patients and parents or requires second treatment sessions. This study introduces a quick-lock additive manufacturing solution for chairside nasal stent exchange called RapidNAM. A novel taping retention pin has been designed that enables nasal stent insertion. Patients with unilateral CLP were included in this study. Plaster models were digitalized and measured by two independent observers. Two methods of CAD/CAM-molding therapies were compared: (i) conventional adhesion of a nasal stent (CAD/CAM NAM); (ii) quick-lock system in which the nasal stent was transferred to another plate (RapidNAM). CAD/CAM NAM and its refinement RapidNAM significantly increased the cleft-side nasal height and tilted the nose towards symmetry. The quick-lock system minimizes wire adaptations, since the pre-existing stent can be reused. The new nasal stent development seems a feasible solution to minimize visiting hours but with clinically satisfactory results. This new nasal stent system combines traditional elements of NAM with CAD/CAM-technology.