Nasolabial Region Research Articles

Topographic Anatomy of the Infraorbital Artery and Its Clinical Implications for Nasolabial Fold Augmentation.

Understanding the topography of the blood vessels distributed around the nasolabial fold region is essential for ensuring the safety of dermal filler injections into the nasolabial fold. The purpose of this study was to provide anatomical information on the infraorbital artery distribution and its relationship with the facial artery for use in clinical procedures involving filler injection during nasolabial fold augmentation. The infraorbital artery was investigated in the nasolabial fold region divided into zones I to XII based on clock-hour meridians centered on the infraorbital foramen. The running layers of the infraorbital artery and infraorbital nerve were also compared in the infraorbital foramen. Changes in the infraorbital artery were observed according to vascular dominance of the facial artery. The infraorbital artery was divided into three main branches, palpebral, nasal, and labial infraorbital artery branches in 34.7, 100, and 100 percent of the specimens, respectively; with these branches of palpebral, nasal, and labial infraorbital artery observed most commonly in zones I, V, and VI, respectively. Analysis of the bilateral facial artery topography revealed that its vascular dominance was observed in 19.4 percent. The infraorbital artery was thicker and had a wider distribution on the nondominant side of the facial artery, whereas the nasal infraorbital nerve anastomosed with the facial artery in the lateral nasal region in 57.1 percent. Investigating and verifying the vascular structure regarding its interactions with the facial artery and infraorbital artery will provide critical information to physicians performing facial surgery and cosmetic procedures.

Incomplete Facial Paralysis: The Use of the Ipsilateral Residual Facial Nerve as a Donor Nerve for Facial Reanimation.

The reconstructive approach for incomplete facial paralysis is not yet determined. In this article, the authors present a new surgical approach for patients with incomplete facial paralysis in which residual, ineffective movement is detected preoperatively in the ipsilateral buccozygomatic territory of the paretic facial nerve. Sixteen patients with incomplete facial paralysis were found eligible for the procedure and underwent one-stage facial reanimation performed by the senior author (E.G.). Reanimation was performed using free gracilis muscle transfer with neural coaptation to an active facial nerve branch(es) responsible for the predetected buccozygomatic residual movement. Patients were reviewed in a systematic fashion using a combined still photographic and video scoring scale for symmetry at rest and at dynamic states. Following surgery, improved symmetry was observed in the majority of observations of the mouth region at rest and while smiling and of the nasolabial fold region while smiling. There was no significant change in symmetry in the majority of observations of the eye region at rest and while smiling and the nasolabial fold region at rest. Video assessment of dynamic facial symmetry while smiling demonstrated improved symmetry in 91 percent of the observations (n = 191 observations). Comparison of mean scores for dynamic smile symmetry produced a statistically significant improvement of 1.68 points following surgery (p < 0.001). Based on this series, the authors recommend that use of the ipsilateral facial nerve buccozygomatic residual branch be considered as a donor nerve for facial reanimation using a free gracilis muscle transfer in patients with incomplete facial paralysis with residual preoperative movement in the midface. Therapeutic, IV.

Hyperdilution of CaHA fillers for the improvement of age and hereditary volume deficits in East Asian patients.

With their high elasticity and viscosity, calcium hydroxylapatite (CaHA) fillers are now widely used to treat age-related or hereditary facial soft tissue volume deficits. CaHA filler volume augmentation is further enhanced by its ability to stimulate neocollagenesis and improve skin quality. However, its high viscosity and cohesivity may hinder its spread and distribution, while its injection by cannula or needle may require moderate extrusion force and lead to uneven distribution or focal accumulation in tissues. Thus, new or modified delivery techniques and tools have emerged, particularly from East Asian physicians. One such technique is hyperdilution with diluents such as lidocaine or normal saline. CaHA hyperdilution appears to be more frequently used by experienced injectors who have varying methodologies. Here, we demonstrate the precise delivery of diluted filler to treat indications related to hereditary volume deficits, volume loss, or aging in the periorbital, nasolabial and submalar regions, marionette lines, and hollowed mid-facial areas. Regardless of age or indication, dilution eases filler delivery for the injector, while using lidocaine as the diluent decreases patient discomfort and minimizes pain. Increasing injection diluent volumes reduces filler thickness (viscosity) and facilitates its even spread, encouraging skin stimulation through more direct contact with tissues and minimizing unevenness. Our results effectively demonstrate that hyperdilution is an innovative and positive evolution in CaHA filler delivery.

Influence of involuntary facial expressions on reproducibility of 3D stereophotogrammetry in children with and without complete unilateral cleft lip and palate from 3 to 18\xa0months of age

ObjectivesTo assess the influence of involuntary facial expressions on 3D facial stereophotogrammetry reproducibility in children with and without unilateral cleft lip, alveolus and palate (UCLP) aged 3–18 months.Materials and methodsThree to eight 3D facial images per time point were acquired within 10 min of 31 children with UCLP and 50 controls at 3, 12 and 18 months of age. 3D mapping of two 3D facial images per subject per age was performed. Distance kits of the full face and nasolabial area were calculated.ResultsIn the total subject pool, mean variation between two 3D facial images ranged from 0.38–0.88 mm. There were no significant differences within groups for the various ages. Variation between controls and UCLP subjects did not differ significantly. Variation was higher in the nasolabial area than in the full face.ConclusionsThe influence of involuntary facial expressions on the estimation of facial growth should not be underestimated, especially in the nasolabial region of UCLP subjects aged 3 months. To improve 3D facial imaging reliability, image capturing should be performed by a trained photographer following a meticulous image capturing protocol, including thorough review after capture.Clinical relevanceFacial 3D stereophotogrammetry is a useful tool for monitoring facial growth longitudinally in young children with facial deformities, as no radiation is involved and image capture is easy and fast. It can be performed reliably in children with and without UCLP aged 3–18 months by an experienced photographer utilising a meticulous image capturing protocol.

Giant solitary trichoepithelioma masquerading as basal cell carcinoma

Trichoepithelioma is a rare benign adnexal tumour which can be of solitary non-familial type or multiple familial trichoepitheliomas. Here authors describe a middle-aged patient who presented with a swelling of the left nasolabial region diagnosed clinically as a basal cell carcinoma but proved to be a giant solitary trichoepithelioma (GST) following histopathological examination. This case is presented due to the rarity and the difficulty encountered in diagnosis of the case.

Longitudinal 3D Assessment of Facial Asymmetry in Unilateral Cleft Lip and Palate.

Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance. Prospective study. Glasgow Dental Hospital and School, University of Glasgow, United Kingdom. Fifteen UCLP infants. The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map. There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up ( P < .05). The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery.

Management of dentoalveolar fracture by using rigid wire and composite splint: A case report

Introduction: Dentoalveolar fractures in adults often occur in the context of daily activities and traffic accidents. Crown fracture is the most common type of lesion, followed by tooth mobility.Case: A 67-year-old woman came to the Emergency Department with bleeding from the mouth because she fells down and her lips hit the bathroom floor. There was no history of unconsciousness, vomiting, and bleeding from ear and nose. The extraoral examination found an asymmetrical face, hematoma on the right eye area, nasolabial region and chin. Edema and hematoma on the upper and lower lip. The intraoral examination was found generalized hyperemia gingiva. The diagnosis was dentoalveolar fracture 12, 22 with crown fracture of teeth 11, 21, 22 accompanied by mobility grade 2 of 12, 11. First treatments are wound debridement, splinting with rigid wire and composite splint, and selective grinding. Panoramic references and prescribing antibiotics and analgesics. Post-action instructions include maintaining oral hygiene, soft diet, radices removal, and return for splinting control. Treatment results show good soft and hard tissue healing. Conclusion: Rigid wire and composite splint are one of the most common and easy fixation techniques to treat dentoalveolar fractures. Simple tools and techniques make rigid wire and composite splint a good treatment for simple dentoalveolar fractures.

Utility of a High-Resolution Superficial Diagnostic Ultrasound System for Assessing Skin Thickness: A Cross-Sectional Study.

Compared with other imaging modalities, ultrasound is relatively deeply penetrating and can be used to evaluate deep dermal and subcutaneous structures. Image skin thickness of the face and neck using high-frequency diagnostic ultrasound devices. Skin overlying 20 different predesignated face and neck anatomic sites in 32 individuals was imaged using 2 commercially available high-frequency diagnostic ultrasound devices, a dedicated imaging device and a diagnostic device bundled with a therapeutic device. At each site, the subcutaneous and combined epidermal and dermal layer thicknesses were assessed by blinded expert raters. Similar skin thickness measurements were obtained. Notably, subcutaneous fat depth was measured to be 0.2 cm at the forehead; 0.5 cm at the mental eminence; and 0.6 cm at the submental, supraglenoid, and temporal regions. The combined epidermal and dermal thickness was approximately 0.1 cm at the zygomatic process, suborbital area, inferior malar region, gonion, supraglenoid area, and nasolabial-buccal, and nasolabial fold regions. This is the first study using high-resolution superficial diagnostic ultrasound to map skin thickness of the face and neck at standard anatomic locations. Ultrasound is an inexpensive, noninvasive, and convenient means to monitor dermatologic conditions and guide their treatment.

Nasolabial aesthetics of patients with repaired unilateral cleft lip and palate: A comparison of three rating methods in two countries

ObjectivesThe study aimed to compare nasolabial aesthetics of patients with unilateral cleft lip and palate (UCLP) treated in Vietnam and Estonia using three rating methods: five-point aesthetic index, a visual analogue scale (VAS), and reference scores method. MethodsA total of 56 patients with repaired UCLP (23 from Vietnam and 33 from Estonia) were included in this cross-sectional study. Patients' facial and profile photographs were cropped to reveal the nasolabial region and coded. Five examiners rated nasolabial aesthetics of the patients using three methods: five-point aesthetic index, 100 mm VAS, and reference scores method. Intraclass correlation coefficients were used to evaluate intrarater and interrater reliabilities. ResultsThe five-point aesthetic index had a higher reliability than VAS and reference scores method. The least aesthetic feature among Vietnamese and Estonian patients was nasal symmetry and nasolabial profile respectively. No differences in nasolabial aesthetics were found between Vietnamese and Estonian patients regardless of the rating methods (p > 0.05) except for nasal symmetry. ConclusionsThe five-point aesthetic index seems to produce more reproducible results. There were no significant differences in nasolabial aesthetics between the two countries. Overall average nasolabial appearance results were obtained using different treatment protocols in the two countries.

A Novel Idea in the Use of Ultrasound to Guide Nasolabial Hyaluronic Acid (HA) Dermal Filler Injections to Prevent Alar Nasal Necrosis

BackgroundNasolabial dermal filler (DF) injections are one of the most popular cosmetic procedures performed worldwide. DF injections at the nasolabial fold have been associated with nasal necrosis due to inadvertent intravascular injection of the adjacent facial artery (FA). Current DF injection protocols are devoid of imaging the anatomical site, and the use of ultrasound (US) for imaging the FA is very limited in literature. The purpose of this study is to determine the feasibility of utilizing US to identify and measure the FA at different bony landmarks near and within the nasolabial region.MethodsPart ICadaveric dissections (n=18; 10 female, 8 male) will be completed to explore the course of the FA from the external carotid artery to the terminal branches supplying facial structures.Part IIA bilateral US of the FA using 13–6 MHz, 38 mm linear array US transducer was performed on consenting adults (n=16; 9 female, 7 male) from the Department of Anatomy and Cell Biology at Western University. The following bony landmarks were identified and used for US measurements, taken in real time: anterior‐inferior angle of the mandible, mandibular teeth, maxillary teeth, maxillary ridge. Measurements of FA diameter, artery distance to skin, and artery distance to bone were obtained at each landmark using digital image distance measurements on the Sonosite M‐Turbo P08189‐88R US machine.ResultsPart IPreliminary results (n=8; 4 female, 4 male) show FA variability between cadaveric specimens, as well as left/right FA variability within cadaveric specimens themselves.Part IIPreliminary results of the average FA distance to the skin measured at 0.438 cm ± 0.126 for the left FA and 0.459 cm ± 0.205 for the right FA. A significant difference (P&lt; 0.05) was noted for FA distance to the skin between the left mandibular teeth (0.481 cm ± 0.107) and left maxillary ridge (0.343 cm ± 0.097).ConclusionsThese findings highlight the importance of understanding the anatomy of the FA within the nasolabial fold, and the need to carefully personalize the placement of DF injections, due to the anatomical variability identified in both the cadaveric and ultrasound portions of the study. Furthermore, since it is feasible to identify and measure the FA using the selected US transducer, the future direction of this study will be to examine the application of US to guide DF injections.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Clinical Implication of the Arterial Supplies and Their Anastomotic Territories of the Nasolabial Region for Avoiding Arterial Devastation and Complications during Soft Tissue Filler injection

BackgroundThe nasolabial fold is one of the most concerning aging property in the middle face region. This fold initially appears when people are coming age‐wise to their 20s. To correct this fold, the aesthetic nonsurgical procedure, known as filler injection, has been popularly and increasingly performed. However, the arterial complications occurring as a consequence of nasolabial fold filler injection have been continually reported in a recent year. Therefore, the objective of this study was to investigate the arterial location related to nasolabial fold filler injection sites and their anastomotic pathways.MethodsThirty hemi‐faces of 15 Thai embalmed cadavers were performed by dissection method. The nasolabial folds (NLF) were used as the anatomical landmarks: at the inferior margin of NLF (NLF1), at the level of the mid philtral horizontal line of NLF (NLF2), and at the inferior alar level of NLF (NLF3). Additionally, the 5 cadavers were underwent the modified Sihler's staining procedure to investigate the arterial anastomoses.ResultsThe main artery nearby of NLF1 and NLF2 was the facial artery. The facial artery located inferior and medial to NLF1 (Type I, 7 of 25 cases); moreover, the mean distance was 3.53 ± 2.11 mm along the X‐axis and 3.53 ± 1.75 mm along the Y‐axis. The facial artery located medial (Type V, 12 of 22 cases) to NLF2 and the distance was 4.93 ± 1.53 mm along the X‐axis. For the NLF3, there were several accurate arteries including the facial artery (10 of 30 cases), the infraorbital artery (9 of 30 cases) and the lateral nasal artery (10 of 30 cases). The anastomosis of the nasolabial arteries was served both as the connection of external‐external carotid system and the connection of internal‐external carotid system. The communication between the facial artery and the transverse facial artery was found in all specimen. Similarly, the communication between the facial artery and the infraorbital artery was seen in all cases. Finally, the anastomosis between the dorsal nasal artery and the lateral nasal artery was found in 5 of 10 (50%) cases.ConclusionAt the lower part of NLF, the facial artery must be concerned. The filler injection should not over approximately 1.5 mm medial to NLF1 and 1 mm inferior to NLF1. For the NLF2, the safe injection point should less than 2.5 mm in the medial direction. In order to prevent injury of the facial artery and the infraorbital artery, the injection tools must not be exceeded 2 mm lateral to NLF3, while the injection less than 2 mm medial to NLF3 is the harmless point for the lateral nasal artery. The possibility of blindness might be caused by the anastomosis between the lateral nasal artery and the dorsal nasal artery.Support or Funding Information The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship from the Graduate School, Chulalongkorn University Overseas Academic Presentation Scholarship for Graduate Students from the Graduate School, Chulalongkorn University This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Facial skin cancers among yemenis patients: A prospective hospital-based study

Objective: the aim is to study the facial skin cancer among Yemenis, determine the common types, common sites, the pattern of the disease, and the possible risk factors associated with it. Materials and Methods: The study is a prospective descriptive hospital-based study carried out at Al-Gomhori Teaching Hospital in Sana'a. The material consisted of Yemen patients attending the Department of Oral and Maxillofacial Surgery and who were diagnosed clinically and histopathologically with having facial skin cancer. Patients who had previous treatment (surgical, radiation, or chemotherapy) or who have recurrent cancer, or who refused to participate in the study were excluded from the study. Results: During the study period, 100 cases of facial skin cancers were seen, 66 cases (66%) were male and 34 cases (34%) were female. The male-to-female ratio was 1.9–1. The majority of patients (94%) were over the age of 40 years, and the peak incidence was the 7th decade of life. Basal cell carcinoma was the most common type accounting for 72% followed by squamous cell carcinoma 27% and malignant melanoma 1%. The infra-orbital region was the most affected site accounting (21%), followed by the naso-labial region and the nose (18%) for each, the temporal region (14%) and the check (12%). Outdoor work was the main risk factor and associated with the development of 70% of facial skin cancer. Conclusion: Facial skin cancers in Yemen still remains the disease of the elderly and deprived patients. The majority of patients (94%) were over the age of 40 years. Males were affected more than females. The male to female ratio was 1.9-1. Basal cell carcinoma was the most common type. Infera-orbital region was the most affected site, followed by the Naso-labial region. Prolonged exposure to sunlight (outdoor work) was the main risk factor that play an important role to development of facial skin cancer among Yemenis.

Soft tissue management to control nasal changes after Le Fort I Osteotomy

Adverse effects in the nasolabial region should be anticipated after Le Fort I osteotomy. Intraoperative factors such as the extent of surgical dissection, type of closure and perinasal soft tissue reconstruction seem to influence soft tissue response. Attempts to control these changes have been made over the years and several techniques have been proposed. The authors present a minimally invasive alternative surgical technique to control alar base widening as well as lip shortening.

Facial Aesthetics in Young Adults after Cleft Lip and Palate Treatment over Five Decades

Cleft Lip and Palate (CLP) - a common facial malformation in newborns – is typically corrected by surgical intervention to allow for normal speech development, psychosocial adjustment, and facial attractiveness. The long term treatment outcome can be evaluated after a number of years, possibly in adulthood. We investigated the aesthetics of the nasolabial region by subjective ratings. To compare various surgical approaches we recruited 12 raters to evaluate 429 patients. Expert and lay raters judged photographs from patients, who have completed treatment with one of three different surgical strategies performed in our institution over 50 years. Facial photographs were cropped, presented to the raters in a randomized sequence, and judged by the raters on a 5 point Likert scale. The subjective ratings between the raters revealed a fair to substantial inter-rater reliability. The average ratings of the surgical outcome improved continuously over the investigated 5 decades. Despite possible differences between raters and rater groups this overall result was consistently seen in the gender groups (male/female), or expertise related groups (expert/lay). Our analysis revealed that patients with bilateral CLP scored worse than patients with unilateral CLP when treated in the fifties; more recently treated patients of both groups scored similarly.

Prevalence and Density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in Erzincan Province.

This study aimed to determine the prevalence and density of Demodex folliculorum and D. brevis in Erzincan Province and the association between Demodex spp. and skin moisture, pH, and temperature. The study included total 300 healthy participants without dermatological ailments and residing in Erzincan Province. Moisture, pH, and temperature of the cheek were measured, and the presence of mite was determined in samples from the cheek, nasolabial, and chin region using the standard superficial skin biopsy technique. The prevalence and density of D. folliculorum and D. brevis were found to be 61.3% (mean 14.3/cm2) and 23.3% (mean 3.2/cm2), respectively, in healthy participants. Infestation by Demodex spp. was greater in the cheek (mean 10.4/cm2), followed by the nasolabial region (mean 7.2/cm2) and chin (mean 6.6/cm2), respectively (p<0.001). The prevalence and density of Demodex spp. were greater in those with dry skin (mean 11.6/cm2), pH of 5.5-7.0 (mean 11.2/cm2), and temperature of 20-23°C (mean 13.1/cm2). Males, with aged >60 years, with lower educational status, and who were single were significantly more infested with Demodex spp. Demodex mites are very prevalent in healthy individuals with different skin moisture, skin pH, skin temperature, and demographic characteristics. This may be taken into consideration when epidemiological and clinical studies are conducted on patients having different dermatological ailments.

Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique

One hundred and one patients with complete or incomplete cleft lip underwent the anatomical subunit approximation technique for repair. The patients were followed up prospectively for 1year. The objective of this study was to determine the outcomes for the nasolabial area through anthropometric measurements and assessment of the Asher-McDade Aesthetic Index and Steffensen’s criteria at 1year after surgery. Six assessors (three cleft surgeons and three non-surgeon medical professionals) examined cropped images; reliability was assessed using Cronbach’s alpha. The difference in lip length between the healthy and operated sides was 0.61mm and the difference in nostril diameter was 0.37mm (differences not significant). The average scar width was 2.78±1.35mm. Hypertrophic scars were observed in 9.9% of cases. The average Asher-McDade Aesthetic Index rating varied between 1.35 and 1.98 for all parameters. Cronbach’s alpha coefficient was 0.83, 0.89, 0.98, and 0.89 for nasal form, nasal symmetry, vermilion border, and nasolabial profile, respectively. Steffensen’s criteria rated appearance as ‘good’ in 69.3% to 91.1% of cases. The anatomical subunit approximation technique can be performed in Sub-Saharan Africans for all types of unilateral cleft lip. It significantly improves the length of the medial and lateral lips, leaving an acceptable scar. A study with a larger sample size and longer follow-up is warranted.

The Use of Fibroblasts for Ameliorating Structural Changes Associated with Skin Aging.

Various causes underlie the structural changes associated with skin aging. To treat these problems, surgical or nonsurgical approaches are available. One of the nonsurgical approaches-regeneration therapy-has become the focus of research and clinical applications. In an earlier clinical study, we injected fibroblasts into the nasolabial region and lips to counter the structural changes associated with skin aging. Assessments performed 12 months after the first injection showed mostly adequate satisfaction scores. However, objective evaluation had not been performed. In the present clinical study, we injected autologous gingival fibroblasts into the nasolabial region and performed objective evaluation using a high-resolution digital camera system 12 months after the first injection. Objective evaluation showed significant improvement in moisture and grain. Subjective evaluation also demonstrated mostly satisfactory results 12 months after the first injection. According to our present results, autologous gingival fibroblast injection might be capable of ameliorating the structural changes associated with skin aging.

Corrective Nasal Surgery after Maxillomandibular Advancement for Obstructive Sleep Apnea: Experience from 379 Cases.

Objective Efficacy of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea (OSA) is associated with degree of maxillary advancement. Large maxillary advancement leads to profound changes of the nasolabial region. We present the incidence and indications of post-MMA corrective nasal surgery in a large cohort. Study Design Case series with chart review. Setting University medical center. Subjects and Methods A total of 379 subjects with OSA underwent MMA at Stanford Hospital (surgeons: S.Y.L., R.W.R.) from August 1992 to December 2015. Data were collected on age, sex, American Society of Anesthesiologists score, polysomnography parameters, and history of nasal surgery. Primary outcome parameters were the incidence and indications of post-MMA corrective nasal surgery. Results Of 379 subjects, the surgical success rate was 76.3% based on the change in respiratory disturbance index. Seventy-one subjects (18.7%) underwent corrective nasal surgery after MMA, whereas 48 underwent functional nasal surgery and 23 underwent both functional and aesthetic nasal surgery. Lower oxygen saturation nadir and higher baseline respiratory disturbance index were associated with increased likelihood of post-MMA corrective nasal surgery. Conclusion MMA surgical success is associated with degree of maxillary advancement, which is especially significant in patients with severe OSA. Patients must be counseled on its impact in nasal function and aesthetics. Our series, the largest to date to address this question, suggests that the incidence of post-MMA corrective nasal surgery is at least 18.7%. Prospectively, refinement in MMA techniques is needed to minimize postoperative compromise in nasal form and function.

A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation

PurposeThe need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system ‘Analyse It Doc’ (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. Materials and methodsAn indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. ResultsAnalysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. ConclusionsThe hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.

A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 2: Comparative anthropometric analysis of patients with repaired unilateral complete cleft lip and palate and healthy individuals

PurposeThe aim of this study was to use a novel system, ‘Analyse It Doc’ (A.I.D.) for a complex anthropometric analysis of the nasolabial region in patients with repaired unilateral complete cleft lip and palate and in healthy individuals. Materials and methodsA set of standardized facial photographs in frontal, lateral and submental view have been taken in 50 non-cleft controls (mean age 20.6 years) and 42 patients with repaired unilateral complete cleft and palate (mean age 19.57 years). Then, based on linear, angular and area measurements taken from the digital photographs with the aid of the A.I.D. system, a photogrammetric analysis of intergroup differences in nasolabial morphology and symmetry was conducted. ResultsPatients with cleft lip and palate differed from the controls in terms of more than half of analysed angular measurements and proportion indices derived from linear and area measurements of the nasolabial region. ConclusionsThe findings presented herein imply that despite primary surgical repair, patients with unilateral complete cleft lip and palate still show some degree of nasolabial dysmorphology. Furthermore, the study demonstrated that the novel computer system is suitable for a reliable, simple and time-efficient anthropometric analysis in a clinical setting.