Nasolabial Region Research Articles

The effect of botulinum toxin A in unilateral cleft lip scar: comparison of results with different sites of injection

Botulinum toxin type A (BTA) injections into the subjacent orbicularis oris muscle have been shown to improve appearance and produce narrower cheiloplasty scars. This study was performed to determine the effect of BTA injected at different sites on the unilateral cleft lip scar and cleft side nostril width. A double-blind, randomized prospective trial was conducted involving 64 consecutive patients with unilateral cleft lip undergoing primary cheiloplasty between September 2016 and January 2019. The patients were randomized to receive BTA injections either into the subjacent orbicularis oris muscle (4 points group) or into the bilateral nasolabial fold region (6 points group) during cheiloplasty. The scars were assessed by photographic scar width measurements and Vancouver scar scale assessment tool. The cleft side nostril width was compared to the non-cleft side width. Fifty-six patients completed the trial, 24 in the 4 points group and 31 in the 6 points group. There was no significant difference in scar width or nostril width measurements between the groups at the end of follow-up. The Vancouver scar scale assessment was also similar between the groups. There was no significant difference in scar width or nostril width measurements after cleft lip repair between patients treated with botulinum toxin injections to the subjacent orbicularis oris muscle and patients treated with injections in the nasolabial region.

S Alar Cinch Suture Effective in Controlling Alar Base Widening in Le Fort 1 Osteotomy?

Le Fort I osteotomy causes nasolabial alterations that may be unattractive, such as expansion of the alae and alar bases and thinning of the upper lip. After maxillary impaction, there is a propensity for the tip to elevate, and in some circumstances, this may even become excessive. The nasolabial angle closes and similar alterations are observed with maxillary advancement. When Le Fort I impaction or maxilla advancement occurs, the alar base cinch suture is frequently utilised to reduce the unfavourable rise in nasal width. There are significant changes in the nasolabial morphology associated with Le Fort 1 osteotomy. Numerous changes occur after the surgical intervention in the maxilla namely- widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip and down turning of the commissures. Widening of the alar bases of the nose appears to be the most common undesirable outcome. Some people may benefit aesthetically from nasal widening. For instance, the long face syndrome is frequently characterised by a narrow nose with a large dorsum. In these situations, superior maxillary relocation typically improves the look of the nose by enlarging the bases of the arches. However, excessive alar base broadening and superior retraction would cause the alar-facial groove to aesthetically deepen, giving the patient an older appearance, and may cause asymmetry in the alas. It is crucial for the surgeon to comprehend the preoperative aesthetic facial linkages and anticipate any potential impact the surgical operation may have on the nasolabial region before performing maxillary surgery. To control the width of the alar base after maxillary osteotomy clinicians have advocated the placement of cinch sutures, reduction of the anterior nasal spine and use of V-Y closure technique. There are inconstant opinions on the effect of the cinch suture.

Comparison of Malassezia Colonization of 'Maskne' Patients with Seborrheic Dermatitis Cases and Healthy Individuals.

With the Covid-19 pandemic, the use of masks has increased the frequency of 'maskne' cases. Local physiological changes due to the use of mask have caused changes in the presence of yeasts in the environment, such as acne and seborrheic dermatitis. The aim is to compare the differences of Malassezia species in the maskne region. A total of 408 subjects wearing masks at least 4 h a day for 6 weeks or longer, compromised of 212 acne patients, 72 seborrheic dermatitis sufferers, and 124 healthy volunteers were included in this study. Swab samples were taken for Malassezia cultures from nasolabial area and their control retro auricular region. The Statistical Package for Social Sciences (SPSS) version 22 was used for the statistical analysis. Malassezia species was most frequently found in the nasolabial region of the seborrheic dermatitis group. Malassezia species were more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, compared to the retroauricular region of each patient, than the healthy subjects. The rate of M. globosa isolated from the nasolabial region was high in all groups, the isolation rate of M. restricta was low (P < 0.05). As Malassezia species are more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, the increasing numbers of Malassezia species will trigger inflammation with an antibody reaction against these yeasts. Treatment of resistant acne and seborrheic dermatitis will be facilitated with the knowledge of this inflammation.

English

Klestadt’s cyst is a rare, benign, developmental, non-odontogenic soft-tissue cyst of the nasoalar region of the midface.1 It is also known as ‘‘nasolabial cyst’’ or ‘‘nasoalveolar cyst’’ (NC). Itis uncommon, affecting 1.6 per 100000 persons each year, more frequently in females in the fourth and fifth decades of life. Characteristic clinical manifestations include slowly enlarging asymptomatic swelling in the nasolabial region, mostly without radiographic abnormalities. Medical advice is usually sought on secondary infection of the cyst or due to the disfigurement caused by it.2 This paper documents the clinicoradiological presentation and management of a nasolabial cyst in a 48-year-old woman and discusses the differential diagnosis of this rare entity

Commentary: Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity.

Sir: We would like to congratulate the authors on an important study that clarifies dogma regarding the unilateral cleft lip nasal deformity.1 A common misperception is that the cleft-side alar base is displaced lateral, and that correction requires medial advancement (Fig. 1A). Just as we have, the authors provide objective evidence of the reverse2: relative to facial midline, the non-cleft alar base is displaced laterally and needs to be centralized (Fig. 1B). Mulliken has proposed that surrounding regional contours may lead to optical illusions of alar base position.3 We feel that the misperception may be due to human cognitive tendencies to reference the more natural appearing non-cleft side when explaining the less-familiar cleft-side contours. Regardless, a clear understanding of the deformity is critical to improving treatment and avoiding iatrogenic anomalies.Fig. 1.: A, Optical illusion. In the absence of facial regions outside the nasolabial region it may seem that correction of the deformity involves downward rotation of the medial lip philtrum and medial advancement of the lateral lip and alar base. B, Context. Facial features and reference lines make the actual displacements readily perceived. The non-cleft alar base and columella need to be centralized, and the cleft alar base needs to be advanced anteriorly. If the lateral lip and alar base were advanced medially, it would produce further imbalance, aggravate the nasal twist, and introduce iatrogenic deformity. Modified with permission from Plast Reconstr Surg 2020:145;185–199.Sakamoto et al analyzed a large sample of photographs and suggested that the cleft alar base is displaced medial relative to age-matched controls.1 Their findings differed from ours in that we found the cleft alar base to be retruded, but normal in medial-lateral position.2 Although they attributed the discrepancy to their larger sample size,1 there are several other explanations to consider. First, whereas our study examined standardized 3D images, they used 2D photographs that involve considerable error from lens distortions, parallax, and uncontrolled head rotation. The appearance of depth from a retruded cleft alar base on 2D images could be extrapolated as variation in medial-lateral position, and error from parallax may be magnified when images are tilted to normalize head position. Second, whereas we measured alar base position using calibrated images with accuracy to within 1 mm, they normalized dimensions on non-standardized photographs using inter-endocantion distance expressed as ratios. These ratios don’t account for the fact that the inter-endocanthion distance widens with increasing cleft severity.2 The findings that Sakamoto et al report may therefore simply be a changing denominator rather than true alteration of cleft alar base position. Although further analysis of well-controlled 3D images would be helpful, the medial position of cleft alar base relative to controls that they report is minimal and may not be of clinical relevance. Most figures depicting unilateral cleft lip nasal deformity crop out facial features beyond the nasolabial region and some research studies advocate that doing so reduces bias when rating esthetic outcomes.4 We are glad to see that Figure 4 in Sakamoto’s article1 is identical to Figure 1 in ours.2 The midline and the endocanthion verticals illustrate the medial-lateral displacements, whereas the alar base horizontals illustrate the relative vertical disparities. Visualization of the whole face allows balance to be judged, and the reference lines guide us to correct perceptions (Fig. 1). We propose that those references should be standard and caution against future research that crops out non-nasolabial regions without providing a mechanism to judge balance. Finally, based on Sakamoto’s,1 Fisher’s,5 and our2 studies, we propose that centralizing the columella and rebalancing the nasal base elements should be the fundamental principle in the correction of the unilateral cleft lip nasal deformity. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques

The aim of this study was to evaluate the nasolabial soft tissues effects in three different Le Fort I osteotomy techniques using cone beam computed tomography (CBCT) evaluation of three-dimensional (3D) volume surfaces.A retrospective study was designed, and three groups were evaluated: group 1, patients who underwent conventional Le Fort I osteotomy; group 2, patients who underwent subspinal Le Fort I osteotomy; and group 3, patients who underwent conventional Le Fort I osteotomy with ANS recontouring or removal. CBCT evaluation was performed at two time points: T0, 1 week before surgery; T1, 6 months after surgery.A total of 90 patients were enrolled in this study (group 1: 30; group 2: 30; group 3: 30). Mean maxillary advancement was 4.26 mm. For group 1, mean change in inter-alar width was 2.29 ± 1.57 mm (minimum -2mm; maximum 6.1 mm; for group 2 it was 1.20 ± 1.56 mm (minimum −1.7 mm; maximum 5.9 mm), and for group 3 was 1.84 ± 1.76 mm (minimum −2.3 mm; maximum 5.9 mm). For group 1, mean change in alar base width was 1.69 ± 2.32 mm (minimum −4.8 mm; maximum 6,1 mm); in group 2 it was 0.85 ± 2.08 mm (minimum -4mm; maximum 6 mm), and group 3 was 1.21 ± 1.83 mm (minimum -2mm; maximum 5 mm). Results showed statistically significant differences in nasolabial area (P < 0.001).Within the limitations of the study it seems that subspinal Le Fort I osteotomy should be preferred when the priority is to avoid changes to the nasolabial region.

Paranasal transposition flap in facial soft tissue reconstruction of facial cleft Tessier type 3 & ADAM complex: A case report.

IntroductionCraniofacial Tessier Cleft type 3 as a common craniofacial cleft with nasolabial region soft tissue defect, forced surgeons to find their ways of reconstructing using localregional flaps to provide defect closure. The cleft may occur in existence with other constriction band syndrome entity such as the ADAM complex. The effort to repair and give back the basic function for daily activity, put surgeons to find ways and one among them are soft tissue reconstruction using most reliable are forehead and melolabial flaps. However, many cases may limit their usages.Case presentationA four-month-old boy presented with ADAM complex syndrome with bilateral facial cleft Tessier 3 was done soft tissue reconstruction to repair the bilateral cleft lips using a combination of the paranasal flap. No early treatment approach such as molding was used. Although the cleft was wide enough, with limitation in flap modality, the wound healing was remarkable with no dehiscence.Clinical discussionThis patient nasal/glabellar flap was not feasible due to glabellar region defect. Some functional and aesthetic limitations of those flaps highlight situations in which the inferior-based interpolated paranasal flap (IPNF) offers an advantageous alternative.ConclusionThus, an alternative flap from inferiorly based paranasal flap proven to be good flap modalities for alar nasal area. This case report shows the good result of design, lacks, and benefit in using paranasal flap.

Reconstruction of Medial Canthal Defects by Local/Loco-Regional Flaps.

To describe a series of medial canthal defect reconstruction by local/loco-regional flaps following excision of basal cell carcinoma. A series of 35 medial canthal defects following excision of basal cell carcinoma was reconstructed by local/loco-regional flaps. For smaller defects, glabellar lateral advancement flap or Limberg's flap from the nasolabial area were used to resurface the defects. For larger defects extending to the upper and lower eyelid or to the nose, a combination of flaps, that is, forehead and cheek rotation flaps or glabellar and cheek rotation flaps were used. In all the cases, the aesthetic and functional results were highly satisfactory except in one, where punctum and lower canaliculi were also excised with the tumor for clearance. This patient complained of watering from the affected eye. Two patients had developed webbing after the operation. It was corrected by Z plasty after 6 months. Medial canthal defects are best managed by local/ loco-regional flaps. For smaller defects in the upper part, the glabellar flap is the choice of the flap and in the lower part, flaps from the nasolabial region give the best result. For larger defects not amenable to single flap, a combination of flaps (glabellar/forehead flap and cheek rotation flap) can close the defects with the good aesthetic and functional results.

A Guide to Bilateral Cleft Lip Markings: An Anthropometric Study of the Normal Cupid's Bow.

The aim of this study was to define the ratio of the heights of the vermilion between the peaks and trough of the Cupid's bow and hence assist in defining the point of closure on the lateral lip element to achieve a balanced Cupid's bow in bilateral lip repair based on our findings. This study is a retrospective observational study of the anthropometrics of the upper lip's Cupid's bow. Three-dimensional (3D) images of toddlers between 2009 and 2016 were extracted from a normative 3D image database of toddlers at the Royal Children's Hospital, Melbourne. Participants from the normative 3D image database at the age of 1 year were studied. This excluded any patients with prior trauma or surgical intervention of the nasolabial region. Landmarks measured were right and left crista philtri (cphR and cphL), labial superius (ls), stomion (sto), right and left chelion, and labial fissure (lf). Vermilion height of the right peak, trough, and left peak of the Cupid's bow was calculated by analyzing the vertical linear distance between cphR-lf, ls-sto, and cphL-lf. The ratio between the median and paramedian heights were recorded. The paramedian height of the upper lip vermilion is consistently greater than the midline height. There was no significant sexual dysmorphism between ratio of paramedian to midline height on the right (P = .538) and left (P = .410). We describe an anthropometric observation of the vermilion relationship at the Cupid's bow and define a specific lateral lip marking for bilateral cleft lip repair based on our anthropometric findings.

Oral Supplementation with Hydrolyzed Fish Cartilage Improves the Morphological and Structural Characteristics of the Skin: A Double-Blind, Placebo-Controlled Clinical Study.

Collagen and its peptides are natural ingredients used in food supplements and nutricosmetics with the claim of providing benefits for skin health and beauty. In this context, the aim of the present study was to evaluate the clinical efficacy of oral supplementation with hydrolyzed fish cartilage for the improvement of chronological and photoaging-induced skin changes. A total of 46 healthy females aged 45 to 59 years were enrolled and divided into two groups: G1—placebo and G2—oral treatment with hydrolyzed fish cartilage. Measurements of skin wrinkles, dermis echogenicity and thickness, and morphological and structural characteristics of the skin were performed in the nasolabial region of the face before and after a 90-day period of treatment using high-resolution imaging, ultrasound, and reflectance confocal microscopy image analyses. A significant reduction in wrinkles and an increase of dermis echogenicity were observed after a 90-day period of treatment with hydrolyzed fish cartilage compared to the placebo and baseline values. In addition, reflectance confocal microscopy (RCM) image analysis showed improved collagen morphology and reduced elastosis after treatment with hydrolyzed fish cartilage. The present study showed the clinical benefits for the skin obtained with oral supplementation with a low dose of collagen peptides from hydrolyzed fish cartilage.

Achieving the Most Effective Hanging Points at the Lower End of the Face for Thread Lifting: Quantitative Measurement of Tissue Resistance in Different Facial Layers.

Summary:The thread lift procedure is a minimally invasive alternative to facelift surgery. The hanging point, which the terminal end of the thread is hooked into, is an important component. If it is loose and cannot stabilize the passage when the inserted thread is pulled, the lifting effect will fail. Therefore, the aim of this study was to elucidate the ability of the tissue to support the thread attachment in the different facial layers while performing this procedure. Twenty hemi-faces of 10 soft cadavers, which were divided into 45 blocks, were used to measure the tissue resistance in the midface area. The resistance of the soft tissue in the four facial layers in each block was measured while a 22G cannula connected with a force gauge was passed through it. The results showed that the tissue resistance in the sub-SMAS was higher than the SMAS and subcutaneous layers in the blocks located in the nasolabial and perioral regions. This was also significantly greater than the resistance in the subcutaneous layer in the three medial blocks below the oral commissure (P < 0.05). However, the low resistance of the sub-SMAS was found in the blocks located in the buccal and lower parotidomasseteric regions. Thus, it was preferable that the hanging point was based in the deep plane (sub-SMAS and SMAS layers) of the nasolabial, perioral, and upper parotidomasseteric regions. Moreover, the sub-SMAS layer within the buccal and lower parotidomasseteric regions should be avoided due to the loose attachment in the buccal capsule and subplatysmal fat.

Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis.

Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.

Clinical, biometric, and ultrasound assessment of the effects of the autologous fibroblast cells transplantation on nasolabial fold wrinkles.

Feeling beautiful and staying young have always been important to the people. Therefore, an extensive body of research has focused on the efforts made to remove the skin problems, especially wrinkles. Fibroblast cells of the skin are the various autologous cells currently used in repairing several wounds, scars, and skin aging. Thus, the present study was conducted to assess the efficacy of the transplantation of the fibroblast cells in eliminating the facial wrinkles using the biometric assessment and to optimize the application of this technique in this treatment. The present study was conducted on 22 male and female patients aged between 35 and 60years old. Samples were collected from the retro-auricular region, and the fibroblast cells were isolated and cultured. Subjects received three injections with autologous fibroblasts at 2-week intervals. The patients were followed up for 6months, and structural changes in their wrinkles were assessed by the sonography and the VisioFace software, cutometer, tewameter, and colorimeter. The results obtained using the VisioFace software showed the significant phenotypic changes in the patients after the nasolabial injections (81.42±23.97 vs. 60.91±21.91, p=0.0001). The results showed a significant increase in the total skin density (13.73±6.30 vs. 26.27±7.93, p=0.0001), dermis density (11.28±5.21 vs. 31.88±7.96, p=0.0001), epidermis density (27.68±23.15 vs. 49.21±45.68, p=0.046), and dermis thickness (798.09±133.51μm vs. 905.59±240.67μm, p=0.036) compared to pre-treatment. The findings of the study revealed that the injection of autologous fibroblasts can be effective in restoring the aging skin, especially in the nasolabial region, and can be used as a safe rejuvenating strategy.

Bone regeneration with platelet-rich fibrin and autologous bone graft after extracting impacted canine. Case report

The objective of this case report is to assess the use of autologous bone graft and platelet-rich fibrin (FRP), as guided bone regeneration, after the extraction of a retained canine. A 42-year-old female patient, with a history of controlled hypertension, attended the SERODU dental clinic (Ecuador), due to the presence of prominence in the left nasolabial region. A Computerized Axial Tomography (CT) was performed, in which tooth 1.3 included in the maxilla was observed, in a horizontal position, the crown mesially and the root distally. It was decided to carry out the extraction of the retained canine and the placement of regenerative biomaterials based on FRP and an autologous bone graft, obtained from the right maxillary tuberosity. Clinical and radiographic controls were carried out after surgery. Six months later, adequate healing and images compatible with bone regeneration were observed in the intervened area.

Bilateral Nasolabial Cyst

Abstract Nasolabial cyst is an uncommon nonodontogenic extraosseous cyst. Bilateral cysts are rare, and very few are reported in literature. They present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. We report a rare case of a 59-years-old female who was diagnosed as bilateral nasolabial cyst based on clinical and computed tomography scan findings and underwent excision by sublabial approach. Histopathological examination confirmed the diagnosis.

Evaluation of Soft Tissue Changes in the Nasolabial and Mental Region After Class Iii Orthognathic Surgery: Systematic Review

Evaluation of Soft Tissue Changes in the Nasolabial and Mental Region After Class Iii Orthognathic Surgery: Systematic Review

Crowd-Sourced Reliability of an Assessment of Lower Facial Aging Using a Validated Visual Scale.

Background:Reliable and valid assessments of the visual endpoints of aesthetic surgery procedures are needed. Currently, most assessments are based on the opinion of patients and their plastic surgeons. The objective of this research was to analyze the reliability of crowdworkers assessing de-identified photographs using a validated scale that depicts lower facial aging.Methods:Twenty photographs of the facial nasolabial region of various non-identifiable faces were obtained for which various degrees of facial aging were present. Independent crowds of 100 crowd workers were tasked with assessing the degree of aging using a photograph numeric scale. Independent groups of crowdworkers were surveyed at 4 different times (weekday daytime, weekday nighttime, weekend daytime, weekend nighttime), once a week for 2 weeks.Results:Crowds assessing midface region photographs had an overall correlation of R = 0.979 (weekday daytime R = 0.991; weekday nighttime R = 0.985; weekend daytime R = 0.997; weekend nighttime R = 0.985). Bland−Altman test for test-retest agreement showed a normal distribution of assessments over the various times tested, with the differences in the majority of photographs being within 1 SD of the average difference in ratings.Conclusions:Crowd assessments of facial aging in de-identified photographs displayed very strong concordance with each other, regardless of time of day or week. This shows promise toward obtaining reliable assessments of pre and postoperative results for aesthetic surgery procedures. More work must be done to quantify the reliability of assessments for other pretreatment states or the corresponding results following treatment.

Secondary Treatment of Cleft Lip Correction Sequelae With Percutaneous Needleotomy, Autologous Fat Grafting, and Local Flaps: An Integrated Approach.

Cleft lip and/or palate (CL/P) is the most common congenital craniofacial malformation. The severity of the anatomic deformity is highly variable and different techniques can be employed depending on whether the defect is unilateral or bilateral, complete or incomplete. Patients usually undergo multiple steps of reconstruction throughout childhood and adolescence and, for this reason, secondary deformities of the nasolabial region of the midface may ensue. Considering our experience in the treatment of scars, we opted to correct the cleft lip surgery sequelae not only with local flaps/scar revisions, but we decided to add the use of the autologous fat grafting (AFG) to induce a regenerative effect in these young patients. In this study we present the results obtained from a series of 12 consecutive Caucasian patients aged from 23 to 44 years with widened paramedian lip scars secondary to cleft lip reconstruction surgery, treated with a combination of needle-induced lysis of the scar tissue and AFG from January 2013 to December 2018. After the procedure we observed an overall improvement in the quality of the scar tissue, in the function of mimic features, in the symmetry and cosmetics of the lower third of the nose. Patients' satisfaction was excellent. Results were long lasting and remained virtually unchanged after 1 year of follow-up. Scar release by needle, AFG and local flaps are excellent tools for the treatment of cleft lip correction sequelae, but the combination of these surgical techniques can lead to even better results.Level of Evidence: Level V.

Evaluation of pronasale, nasolabial and paranasal asymmetries in patients with unilateral cleft lip and palate using three-dimensional imaging

Objective: Facial symmetry is an important component of a successful treatment of patients with cleft lip and palate. The aim of this retrospective study was to examine the pronasale, nasolabial, and paranasal region asymmetries in patients with nonsyndromic unilateral cleft lip and palate (UCLP) using three-dimensional (3D) facial imaging.Materials and Method: The study group consisted of 29 patients with complete UCLP aged 8–29 years. 3D stereophotogrammetric soft tissue recordings of all patients were analyzed. Measurements were performed on the cleft and noncleft side and compared with each other by the paired t-test.Results: Statistically significant differences were observed between the cleft and noncleft sides. Alar contour-Pronasale distance was longer on the cleft side than on the noncleft side, with the difference between them being statistically significant (p&amp;lt;0.05). The Subnasale-Pronasale / Alar contour-Pronasale ratio was also significantly lower on the cleft side than on the noncleft side (p&amp;lt;0.05).Conclusion: Patients with UCLP did not present significant asymmetries regarding Cheek and Buccal contours and Chelion-Subnasale and Christa Philtry-Subnasale heights. Asymmetrical appearance was prominent on alar base and pronasale regions.

The Validation of an Innovative Method for 3D Capture and Analysis of the Nasolabial Region in Cleft Cases.

Objective:To validate a newly developed method for capturing 3-dimensional (3D) images of the nasolabial region for assessing upper lip scarring and asymmetry in surgically managed unilateral cleft lip and palate (UCLP) cases.Design:Validation study, single cohort.Materials and Methods:Eighteen surgically managed UCLP cases were recruited, the nasolabial region of each face was scanned using an intraoral scanner (IOS) to produce 3D images. The images were manually segmented to allow the calculation of surface area of the scar and upper lip asymmetry. Five professionals and 5 lay assessors subjectively evaluated the same images and graded the upper lip scarring and asymmetry at 2 separate occasions. The relationship between the subjective and objective assessments was evaluated.Results:Moderate correlation was found between subjective and objective evaluations of the upper lip scarring and total asymmetry. The captured 3D images were of good quality for the objective measurements of lip asymmetry and residual scarring. Moderate to strong correlations were detected between the 2 panels (T ranging between 0.5 and 0.9) with no significant difference (P > .05) in the mean score of the subjectively evaluated parameters.Conclusion:The IOS is a useful tool for the capture of the nasolabial morphology. The captured 3D images are a reliable source for measuring lip asymmetry and scar surface area. The method has sufficient validity for routine clinical use and for objective outcome measures of the surgical repair of cleft lip.