Noncleft Side Research Articles

Nasal Airflow Dynamics Before and After Septorhinoplasty for Correction of Cleft Lip Nasal Deformity: A Single Patient Case Report

Background: Unilateral cleft lip nasal deformity (uCLND) creates multiple sites of nasal airway obstruction, impacting patients’ quality of life. Surgical restoration of function remains technically challenging and complex. Objectives: This is a single patient case report to determine consistency of patient’s subjective perception of nasal outcomes after septorhinoplasty with objective assessments, and effectiveness of standard surgical techniques in targeting sites of greatest nasal anatomical obstruction. Method: Patient-reported quality of life (QOL) measures were collected. Pre- and post-surgery radiographic images of a patient with uCLND were obtained for computational fluid dynamics (CFD) modeling of patient-specific nasal function. Objective assessments were obtained using rhinomanometry and CFD. CFD-derived localized resistance at multiple cross-sectional segments were determined and used to identify greatest nasal obstructive sites. Results: Patient-reported QOL scores improved by 20 to 73 points. CFD-calculated bilateral resistance decreased from 0.155 to 0.061 Pa.s/ml, cleft-side resistance from 0.407 to 0.091 Pa.s/ml, and non-cleft-side from 0.228 to 0.120 Pa.s/ml. Rhinomanometry showed similar decreases in resistance. On the cleft side, 25 identified sites of greatest obstruction decreased to 15 sites post-surgery; on the non-cleft side, 23 sites of greatest obstruction decreased to 16 sites post-surgery. Conclusion: Results suggest improvement in nasal patency after septorhinoplasty. Additional greatest obstructive sites in the post-surgical airway were mostly around the superior airway.

Three-Dimensional Evaluation of Nasolabial Morphology After Applying Presurgical Nasoalveolar Molding in Primary Unilateral Cheiloplasty Using the Modified Millard Technique.

To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. Descriptive clinical study with one group, prospective. Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. Interventions include PNAM and cheiloplasty by modified Millard technique. Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side.

Correction of narrow nostril deformity secondary to cleft lip: indications for different surgical methods and a retrospective study.

Cleft lip and/or palate (CLP) can lead to severe nasolabial deformities that significantly affect the appearance of the patient. Among all types of nasolabial deformities, narrow nostril deformities are the most troublesome, causing poor and unstable surgical outcomes. The purpose of this study was to develop an algorithm for surgical method selection for revision of narrow nostril deformities secondary to CLP based on retrospective clinical data. Patients with narrow nostril deformities secondary to CLP were enrolled in the study. Before surgery, patients' clinical data were collected and the width of the nasal floor and the length of the alar rim were measured. Surgical methods were determined according to the measurements. After surgery, a nostril retainer was applied for 6 months to consolidate and maintain the nostril shape. The surgical method and postsurgical changes were recorded for the final summary of the algorithm to select surgical methods for narrow nostril deformities. The data from 9 patients were analyzed. According to the width of the nasal floor and the length of the alar rim, correct surgical methods were determined. Four patients received nasolabial skin flaps to widen the soft tissue of the nasal floor. Three patients received upper lip scar tissue flaps to treat the narrow nasal floor. For the short alar rim, free alar composite tissue flap or narrowing of the nostril of the noncleft side was recommended. The width of the nasal floor and the length of the alar rim are critical elements to consider when selecting the correct surgical method for revising narrow nostril deformities secondary to CLP. The proposed algorithm provides a reference for selecting surgical methods in future clinical practice.

Characterizing Olfactory Dysfunction in Patients with Unilateral Cleft Lip Nasal Deformities.

Background: Unilateral cleft lip nasal deformity (uCLND) is associated with olfactory dysfunction, but the underlying etiology remains poorly understood. Objective: To investigate the etiology of uCLND-associated olfactory dysfunction using clinical, computational, and histologic assessments. Methods: Inclusion criteria: uCLND patients >16 years undergoing septorhinoplasty. Exclusion criteria: prior septoplasty or rhinoplasty, pregnancy, sinusitis. Measured outcomes: patient-reported scores, rhinomanometry, smell identification and threshold tests, computational fluid dynamics (CFD) airflow simulations, and histologic analysis of olfactory epithelium. Results: Five uCLND subjects were included: 18-23 years, three male and two female, four left-sided cleft and one right-sided cleft. All subjects reported moderate to severe nasal obstruction. Smell identification and threshold tests showed varying degrees of hyposmia. Nasal resistance was higher on the cleft side versus noncleft side measured by rhinomanometry (median 3.85 Pa-s/mL, interquartile range [IQR] = 21.96, versus 0.90 Pa-s/mL, IQR = 5.17) and CFD (median 1.04 Pa-s/mL, IQR = 0.94 vs. 0.11 Pa-s/mL, IQR = 0.12). Unilateral olfaction varied widely and was dependent on unilateral percentage olfactory airflow. Biopsies revealed intact olfactory neuroepithelium. Conclusions: uCLND-associated olfactory dysfunction appears to be primarily conductive in etiology and highly susceptible to variations in nasal anatomy. Clinical Trial Registration number: NCT04150783.

Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip.

Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients ( n = 13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for three-dimensional morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. Three-dimensional morphometric analysis revealed a significant (all P < 0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference ( P > 0.05) between cleft and noncleft sides. The postoperative three-dimensional projection of the philtral ridges was significantly ( P < 0.001) larger in cleft (1.01 ± 0.43 mm) than in noncleft sides (0.51 ± 0.42 mm). The average philtrum volume change was 1.01 ± 0.68 cm 3 , with an average percentage fat graft retention of 43.36% ± 11.35%. The panel assessment revealed significant ( P < 0.001) postoperative scar enhancement for the qualitative rating scale, with mean preoperative and postoperative scores of 6.69 ± 0.93 and 7.88 ± 1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. Therapeutic, IV.

Alar Asymmetry in Patients with Unilateral Cleft Lip: Implications for Secondary Rhinoplasty.

Alar asymmetry in unilateral cleft lip (UCL) nasal deformity is a well-recognized clinical feature. However, there is a lack of comprehensive quantitative analysis of this asymmetry. This study compares the shape, volume, and axis rotation between the cleft and non-cleft ala in skeletally mature patients with UCL. A retrospective comparative study utilizing three-dimensional rendered CT scans. Tertiary care pediatric institution. This study included 18 patients with UCL nasal deformity at skeletal maturity. Cleft and non-cleft side ala volume, surface area, and axis to the midsagittal plane. The cleft-side ala was significantly lesser in volume by 27.3%, significantly lesser in surface area by 17.6%, and significantly greater in surface area to volume ratio by 14.6% than the non-cleft ala. The cleft-side ala was significantly greater by 43.1% horizontal axis to the midsagittal plane. In patients with primary rhinoplasty, the cleft-side ala had 28.0% less volume and 18.7% less surface area. In intermediate rhinoplasty, the cleft-side ala had 39.1% less volume and 23.5% less surface area than the non-cleft ala. Significant asymmetry exists between the cleft-side and non-cleft ala in patients with UCL. The cleft-side ala is significantly smaller in volume and surface area than the non-cleft ala. Additionally, the cleft-side ala demonstrates a significantly greater horizontal axis that contributes considerably to nasal asymmetry, supporting the need to restore a normal vertical axis to the clef-side ala.

Evaluation of the Effect of Surgical Repair on Lip-Nose Morphometric Parameters of Patients with Unilateral Cleft Lip using Two-Dimensional Photogrammetry: A Comparative Study between the Cleft and the Non-Cleft Side.

This prospective, comparative study was carried out to evaluate the effect of cleft lip repair on lip-nose morphometric characteristics of subjects with complete unilateral cleft lip/palate at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. The study population consisted of a total of 29 subjects. Lip repair was done using Millard's rotation advancement technique by a single consultant. Standardised photographs were taken; preoperatively and during different postoperative periods; immediately, 1 week, 3, and 6 months. Indirect measurements of eight linear distances were carried out using Rulerswift software application. For all statistical analyses of mean difference, a P-value of less than 0.05 was accepted as being statistically significant. A total of 52% were women, whereas 44% were men. There are considerable disparities between the cleft and non-cleft sides of complete unilateral cleft patients before surgery; statistically significant differences of 1.4 mm, 6.3 mm, and -17.6 mm in vertical lip height, philtral height, and nasal width respectively. Six months after repair, statistically significant differences in lip height between the cleft and the non-cleft side were observed in vertical lip height, nasal width, and philtral height (mean difference of -1.28 ± 0.78, 2.02 ± 2.86, 1.22 ± 1.83 mm; P < 0.001, P = 0.016, P = 0.022, respectively). Horizontal lip height was maintained with no statistically significant difference (mean difference of -0.12 ± 2.19 mm). Following cleft repair, using Millard's rotation advancement technique, differences in lip-nose morphometric parameters were found to be reduced, however, not always eliminated by treatment.

Three-Dimensional Pulp Volume Analysis in Lip and Palate Cleft Population

Aim: Cleft lip and palate (CLP) patients have a greater predisposition to tooth malformation, which could affect pulp volume. The aim of this study is to evaluate the dental pulp volume of central incisors in 3D images between individuals with and without CLP. Materials and Methods: This retrospective case-control study is single-centered and was recruited between January 2016 and October 2022. Ninety-four patients who were followed in the Institute of Orthodontics were evaluated and divided into two groups: a control group of patients without CLP and a test group of patients with CLP. The 3D data were imported by 3D image semi-automatic segmenting software named ITK-SNAP to calculate tooth pulp volume. Results: The dental pulp volume for both groups, control and CLP, did not show statistically significant differences. In the cleft group, when comparing the pulp volume between the cleft side and the non-cleft side, the cleft side showed a smaller volume. Regarding age and sex, no statistically significant differences were observed. Conclusions: Although there are no differences in mean pulp volume between patients with and without CLP, there is a pulp volume reduction in the teeth on the cleft side when compared to the unaffected contralateral side.

The Asymmetry Within: A Renewed Look at Cupid’s Bow in Unilateral Cleft Lip

Objective: All unilateral cleft lip (UCL) repair techniques assume and describe a displaced or obliquely rotated Cupid’s bow within the cleft prolabium. This is true, but there is more. A focused anatomic description of the prolabium, and the configuration of Cupid’s bow within the prolabium, in UCL is deficient in the literature. The purpose of this study was to analyze the prolabium in unmanipulated (pre-NAM, pre-surgical) UCL patients, with or without palatal clefts, with emphasis on the size, shape, and symmetry of the Cupid’s bow within the prolabium itself. In addition, a geometric analysis conveys the most efficient location for incisional correction of the “asymmetry within” Cupid’s bow. Methods: Standardized frontal photographs of 37 infants with UCL were studied by experienced craniofacial team members. Cupid’s bow landmarks were identified and prolabial angles (perpendicular through valley to bow height) were recorded on both the cleft and non-cleft sides. Three groups were analyzed (all n=37, complete n=22, incomplete n=15). Unpaired t-test and two-tailed t-test were utilized for statistical analysis. A geometric linear analysis was preformed to show incisional length and location for correction of the asymmetric Cupid’s bow. Results: Significant intrinsic Cupid’s bow asymmetry within the prolabium was present in all groups. This asymmetry was exhibited by significance (p<.0001) between angles in all groups. For all UCL the mean difference between angles was 4.992 degrees. (p<.0001) The largest mean difference was 7.608 degrees (95% CI: 4.927-10.289 degrees; p < 0.0001) in the incomplete group. Conclusions: In UCL not only is the prolabium with its concomitant Cupid’s bow rotated upwards into the cleft, but there exists a significant intrinsic asymmetry of the Cupid’s bow itself within the prolabium. This intrinsically asymmetric Cupid’s bow is then rotated upwards into the cleft itself. This finding has yet to be described in the cleft literature. Furthermore, a linear geometric equation describes incisional locations and lengths within the prolabium for correcting the Cupid’s bow asymmetry. This finding enhances our anatomic understanding of UCL and has significant importance when selecting surgical repair techniques. Corresponding Author: Ellie Gschwendtner, 2365 Orchard Circle Dr. Unit 13, Traverse City, MI 49686

Comparison of Missing Permanent Tooth in Bangladeshi Unilateral Cleft Lip and Palate to those without Cleft Lip and Palate

Background: The distribution of dental abnormalities specially missing tooth is common among the cleft palate &amp; lip patient wherefore the aim of this study was to evaluate the prevalence of hypodontia in case of Bangladeshi cleft population.&#x0D; Objective: The purpose of the present study was to compare the congenital tooth deficiencies seen in permanent dentition in individuals with unilateral cleft lip and palate (UCLP) to non-cleft individuals with Angle Class I malocclusion.&#x0D; Methodology: This is a retrospective case control study between UCLP and Angle Class l malocclusion patients. This study was done on OPG films taken before treatment from 80 patients who applied for orthodontic treatment. 40 individuals with UCLP between the ages of 12 - 16 years were compared with the 40 individuals with Angle Class I malocclusion with no CLP aged between 12 - 16 years. Individuals with UCLP; 21 clefts were on the left side and 19 clefts were on the right side. The congenitally deficient teeth were recorded from the OPG films. In this study, third molars were not included in the evaluation.&#x0D; Results: In this study, no differences were found in regard to the gender of the patient. The left side of the patients was affected substantially more than the right side. The frequency of the missing upper lateral incisors in the cleft side of the patients was significantly higher than the non-cleft side. Therapists of cleft patients need to be aware of the high variety of numerical alterations, as this is important for therapy planning and the applied treatment.&#x0D; Conclusion: The management of dental anomalies, which can easily be detected by careful inspection of routine orthodontic diagnostic records, should be taken into consideration in treatment planning of individuals with a cleft.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):198-201

Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla

BackgroundMachine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed.MethodsPreoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side.ResultsOne-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant.ConclusionThe auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.

Comparison of the Paranasal Sinus Features of Paediatric Patients with and Without Cleft Palate: A CBCT Study.

This study is performed to compare the paranasal sinus volumes in paediatric unilateral cleft palate (UCP) and healthy patients. Cone-beam computed tomography (CBCT) images of 80 patients (40 boys, 40 girls) with UCP and 80 healthy individuals (40 boys, 40 girls) were evaluated. Paranasal sinus volumes were segmented and measured using ITK-SNAP software. Descriptive statistics, Kolmogorov-Smirnov, paired sample t-test and student t-test were performed for statistical analysis. The volumes of ethmoid, frontal and sphenoid sinus on the cleft side were not significantly different than the non-cleft side (p>0.05) in UCP patients. Maxillary sinus volume of the cleft side in UCP patients was significantly lower than the non-cleft side (p<0.05). Mean maxillary sinus volume in UCP patients was 11825.23±509.95 mm3 at the cleft side and 13497.85±358.07 mm3 at the non-cleft side. While the mean volumes of ethmoid and sphenoid sinuses of patients with UCP were not significantly different from healthy individuals (p>0.05), the mean volumes of maxillary and frontal sinuses were significantly lower than healthy individuals (p<0.05). The mean maxillary sinus volume in UCP patients was 25323±597.8 mm3 and 26666±874.3 mm3 in the control group. The mean frontal sinus volume in UCP patients was 5633±323.1 mm3 and 5735±315.2 mm3 in the control group. UCP caused a significant reduction in maxillary and frontal sinus volumes. The results of the current study show that paranasal sinus volumes in patients with UCP should be examined in more detail to make more risk-free and effective treatment plans.

Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment

To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis. This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05). At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º). Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

Transverse differences between cleft lip and palate and non-cleft palate with skeletal Class III malocclusion using buccolingual inclination: a cone-beam computed tomography retrospective study

BackgroundThe purpose of this study was to evaluate the differences between buccolingual inclination (BI) of maxillary posterior teeth in patients with cleft lip and palate (CLP) and non-cleft palate with skeletal Class III malocclusion. We propose a method of maxillary expansion which is more suitable for patients with CLP.MethodsFor this retrospective study, 40 patients with CLP and 21 patients with skeletal Class III malocclusion were selected. The CLP group was divided into the unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) groups. The BI of the maxillary first premolar (BI4), maxillary second premolar (BI5) and first molar (BI6) were measured using cone-beam computed tomography, and the differences between them were compared and analyzed by Student’s t-test.ResultsThere were significant differences between cleft side BI4 and non-cleft side BI4 in the UCLP group, BI5 in the BCLP group, BI4 and BI5 in all CLP groups and the skeletal Class III malocclusion group. BI6 was similar across all three groups.ConclusionsThe premolars of patients with CLP do not exhibit the same regularity as those with Class III malocclusion; this may be related to surgical scarring of the cleft palate. Greater attention should be paid to the correction of BI in the maxillary expansion of patients with CLP.

The Yin and Yang of Primary Unilateral Cleft Lip and Nose Repair: Balance through Opposing Cleft and Noncleft Side Changes.

Balance is achieved through opposing interactions. Objective three-dimensional assessment of changes during surgical treatment of the unilateral cleft lip and nasal deformity are limited, and false assumptions may prevent optimal management. The authors performed anthropometric analysis on the immediate preoperative and postoperative images (captured under anesthetic) of patients undergoing primary repair ( n = 36). Changes in dimensions and measures of balance were assessed ( P < 0.05). Angles and ratios that reflect cleft to noncleft side balance normalized, although alterations occurred in opposing ways. Centralization of the columella narrowed the cleft nasal base and widened the noncleft nasal base. As the cleft columellar height elongated, the noncleft columellar height shortened. With these changes and correction of cleft alar base retrusion, the cleft alar dome was raised. The cleft and noncleft lateral lip heights and widths elongated. Meanwhile, the Cupid's bow broadened as the commissures were drawn closer together. Whereas the cleft philtral height lengthened, the noncleft philtral height shortened. Reduction in noncleft philtral height averaged 20% but varied with measures of preoperative severity including columellar angle ( R = 0.67), the difference in philtral heights ( R = 0.65), and lateral deviation of the subnasale ( R = 0.74). Tissue does not need to be added to "lengthen" the columella, the noncleft philtral height shortening can be estimated, and the contours of anatomic subunits change with surgery on both cleft and noncleft sides. It is inadequate to focus on correction of the cleft side alone without considering corresponding noncleft side changes. Achieving balance through opposing alterations should be the principal goal of treatment. Therapeutic, IV.

Symmetry of the Vermillion Height after Modified Rotation-Advancement Cheiloplasty.

(1) Background: This study aimed to determine the postoperative vermillion symmetry between the cleft and non-cleft sides of patients with unilateral cleft lip during the early and late postoperative periods. (2) Methods: 57 patients with complete and 38 with incomplete unilateral cleft lips operated on between 2010 and 2014 were retrospectively evaluated within 1 month (T1), 9 months to 1 ½ years (T2), and more than 4 years (T3). Vermilion heights of the cleft and non-cleft sides were measured from frontal photographs. The Cleft Lip Component Symmetry Index (CLCSI) was used to determine the symmetry of the cleft and non-cleft sides and was then analyzed. (3) Results: Among the 95 patients studied, vermilion height was excessive on the cleft side throughout the three time periods. There was a significant increase in CLCSI from T1 to T2 for both complete and incomplete types, and a significant increase from T1 to T3 only in the incomplete group and no difference from T2 to T3 for both the groups. (4) Conclusions: Even with efforts to obtain a symmetric vermilion height during the primary cheiloplasty, vermilion height excess was noted with time in complete and incomplete cleft types. Secondary revisional vermilion surgery may be performed to achieve symmetry.

Novel Reconstruction of Orbicularis Oris in Unilateral Complete Cleft Lip Repair.

Background: Orbicularis oris muscle repair is key to successful unilateral cleft lip repair. Objective: To measure the lip symmetry after repair of the lip muscles in the midline compared with traditional repair on the cleft side. Methods: A retrospective review and photographic analysis of patients with complete cleft lip treated with the modified approach were carried out. Anthropometric analysis was done at pre-, immediate, and 1-year postoperatively, and at 1-year follow-up. Four upper lip and six nostril landmarks were measured. Results: Fourteen patients met inclusion criteria. Immediate postoperatively, the horizontal lip length on the cleft side was shorter than that on the noncleft side, but the discrepancy decreased as facial development progressed over the course of a year. Lip measurements at the 1-year follow-up were approximately symmetrical in vertical lip height, philtral height, and lateral lip height. Small changes in the nasal correction occurred at 1 year. Conclusion: A modified technique in the unilateral complete cleft lip repair seeks to balance the perinasal and perioral muscles and improve symmetric outcomes.

Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty.

Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes. Balance between AP nostril diameters was accomplished by reduction of the AP diameter of the nostril at the non-cleft side by medial crural reduction and augmentation of the AP diameter of the nostril at the cleft side by three-parted mini-flap reconstruction at the soft triangle. The cleft-side AP diameter length was divided by the non-cleft-side AP diameter length of the same preoperative, per-operative and 1-year postoperative base view photographs of each patient, and "nostril balancing ratio" was obtained. The more this ratio was near to "one," the more the AP nostril diameters were equal. Seventy-eight unilateral-cleft rhinoplasty were performed between January/2019 and May/2022. Forty-two of them required nostril AP diameter equalization. Twenty-nine patients were female, thirteen were male. Thirty-three of them were operated for a primary cleft rhinoplasty. Nine of them for secondary cleft rhinoplasty. Mean age was 28years (22-39years). Mean follow-up was 25months (6-40months). The preoperative, per-operative and postoperative mean "nostril balancing ratios" were 0.714 (0.621-0.813), 0.743 (0.721-0.752) and 0.971 (0.943-0.976), respectively. Balancing AP diameter symmetry with MCO at the non-cleft side and three-parted mini skin flap reconstruction at the cleft side may provide the satisfactory results. Three mini-flaps at the soft triangle may remold the nostril apex in an oval shape, which may result in a better shape symmetry. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Midfacial Soft Tissue Changes After Anterior Maxillary Segmental Distraction Osteogenesis in Patients With Cleft: A 3-Dimensional Volumetric-Based Subunit Analysis.

Maxillary hypoplasia is common in patients with cleft lip and palate. In this study, the authors investigated the soft tissue changes in midfacial regions after anterior maxillary segmental distraction osteogenesis (AMSDO) in patients with cleft. Eight patients with cleft lip and palate who underwent AMSDO were enrolled in this study. Spiral computed tomographic images were taken before surgery and 6-12 months after surgery to evaluate soft tissue changes after AMSDO. The midfacial area was divided into 6 regions of interest according to anatomical subunits. The average movements of each region were calculated using volumetric changes and preoperative region surface areas. The upper lip on both sides has the most anterior movement (5.22±0.86 and 5.14±0.84mm), supracommissural regions have a little less movement (4.11±0.55 and 3.81±0.67mm), paranasal regions have the least movement (3.37±0.47 and 3.15±0.36mm). The corresponding regions of interest showed no significant difference on the cleft side versus the noncleft side. Anterior maxillary segmental distraction osteogenesis can improve the soft tissue profile in patients with cleft, and there was no significant difference in soft tissue changes between the cleft side and the noncleft side.

Does Differential Maxillary Expansion Prior to Alveolar Cleft Bone Grafting Affect Nasal Width?

Determine the effects of differential maxillary expansion on nasal width in patients with unilateral cleft lip and alveolus with or without cleft of the secondary palate (UCLA ± P). Retrospective radiographic study. Institutional. Forty patients with UCLA ± P who had alveolar bone grafting (ABG) between 2015 and 2020 and available preexpansion and postexpansion cone beam computed tomography (CBCT) scans. Twenty patients with UCLA ± P who underwent ABG without expansion were included as controls. Percent change in width at the nasal pyriform, inferior turbinates, and alar base on cleft and noncleft sides. The study included 40 patients (24 males, mean age 9.6 years) and 20 controls (10 males, mean age 10.1 years). After maxillary expansion, there was an increase in width on the cleft and noncleft sides compared to nonexpanded controls at nasal pyriform (10.9% cleft side, P ≤ 0.001 and 4.3% noncleft side, P ≤ .001), inferior turbinate (8.7%, P ≤ .001 and 4.5%, P = .01), and alar base (6.7%, P = <.001 and 0.8% P = .54). The increase in width was greater on the cleft side than the noncleft side at the nasal pyriform (7.1%, P ≤ .001), inferior turbinate (4.3%, P ≤ .001), and alar base (7.0%, P ≤ 0.001) in the expansion group. There was good to excellent intra-rater and inter-rater agreement for measurements. Patients with UCLA ± P who undergo differential maxillary expansion before ABG exhibit greater nasal widening on the cleft side.