Nostril Area Research Articles

Long-term Results and Efficacy of Intermediate Rhinoplasty in Patients With Unilateral Cleft Lip: A Single Surgeon's Experience.

Intermediate rhinoplasty, the correction of cleft lip nose deformities, is performed between the time of primary and secondary rhinoplasties, which is at ~6 years of age. Although intermediate rhinoplasty reduces psychological stress in school-aged children through improvements in appearance, studies on intermediate rhinoplasty are scarce. Hence, in this study, we aimed to evaluate the long-term outcomes of intermediate rhinoplasty in patients with unilateral cleft lip. Twenty-three patients with unilateral cleft lip who underwent intermediate rhinoplasty without primary rhinoplasty from 1997 to 2004 were enrolled in this retrospective study. They were categorized into total, male, and female groups. Photogrammetric analysis of 9 proportional, 5 angular, and 6 nostril-related parameters was performed using photographs that were taken after skeletal maturity had been reached; these parameters were compared with those of normal controls. The cleft group had significantly lower dome-to-columellar ratio, nasal sill ratio, labial-columellar angle, nostril width ratio, nostril height (base) ratio, nostril one-fourth medial part ratio, and nostril area ratio measurement and significantly higher alar width/mouth width ratio, columella height/alar width ratio, nasal tip protrusion/alar base width ratio, nasal dorsum angle, and nostril dimension in the cleft side values than the control group. After intermediate rhinoplasty, significant nasal improvement was achieved, including sufficient nasal tip projection, nasal height, nasal protrusion, and a relatively symmetric nasal tip without tip deviation. Intermediate rhinoplasty may contribute to reducing the psychosocial stress of school-aged children with unilateral cleft lip.

Observation of Nasal Morphology in Unilateral Microform Cleft Lip Repaired by a Hidden Skin Incision.

Microform cleft lip is the mildest type of cleft lip without obvious defects of the upper lip. The nose deformities of microform cleft lip include flattened nostril rim, alar base asymmetry, and septal deviation. A hidden skin incision with nasal base muscle reconstruction was introduced in nose deformities of microform cleft lip. To investigate the operative effect, we reviewed 21 patients with microform cleft lip treated with a hidden skin incision with nasal base muscle reconstruction from May 2020 to October 2022. Photogrammetric nasal morphometric measurements were compared preoperatively and six months postoperatively. The proportional value was obtained from the cleft and the noncleft sides, and paired t-test analysis was used to evaluate the surgical outcome. Significant differences were found in all nasal morphologic measurements at 6 months postoperatively compared to preoperatively (p < 0.05). After surgery, the alar base and nostril were narrowed, while the lateral lip height was increased on the affected side. The height of the nostrils on the affected side was increased, and the nasal columella deviation was released. In addition, the ratio of the cleft-to-noncleft nostril area was closer to 1.0 after surgery. The unilateral microform cleft lip nasal deformity can be repaired through a small hidden incision. 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 .

Detection of Respiratory Rate of Dairy Cows Based on Infrared Thermography and Deep Learning

The respiratory status of dairy cows can reflect their heat stress and health conditions. It is widely used in the precision farming of dairy cows. To realize intelligent monitoring of cow respiratory status, a system based on infrared thermography was constructed. First, the YOLO v8 model was used to detect and track the nose of cows in thermal images. Three instance segmentation models, Mask2Former, Mask R-CNN and SOLOv2, were used to segment the nostrils from the nose area. Second, the hash algorithm was used to extract the temperature of each pixel in the nostril area of a cow to obtain the temperature change curve. Finally, the sliding window approach was used to detect the peaks of the filtered temperature curve to obtain the respiratory rate of cows. Totally 81 infrared thermography videos were used to test the system, and the results showed that the AP50 of nose detection reached 98.6%, and the AP50 of nostril segmentation reached 75.71%. The accuracy of the respiratory rate was 94.58%, and the correlation coefficient R was 0.95. Combining infrared thermography technology with deep learning models can improve the accuracy and usability of the respiratory monitoring system for dairy cows.

Thermal Image Processing for Respiratory Estimation from Cubical Data with Expandable Depth.

As healthcare costs continue to rise, finding affordable and non-invasive ways to monitor vital signs is increasingly important. One of the key metrics for assessing overall health and identifying potential issues early on is respiratory rate (RR). Most of the existing methods require multiple steps that consist of image and signal processing. This might be difficult to deploy on edge devices that often do not have specialized digital signal processors (DSP). Therefore, the goal of this study is to develop a single neural network realizing the entire process of RR estimation in a single forward pass. The proposed solution builds on recent advances in video recognition, capturing both spatial and temporal information in a multi-path network. Both paths process the data at different sampling rates to capture rapid and slow changes that are associated with differences in the temperature of the nostril area during the breathing episodes. The preliminary results show that the introduced end-to-end solution achieves better performance compared to state-of-the-art methods, without requiring additional pre/post-processing steps and signal-processing techniques. In addition, the presented results demonstrate its robustness on low-resolution thermal video sequences that are often used at the embedded edge due to the size and power constraints of such systems. Taking that into account, the proposed approach has the potential for efficient and convenient respiratory rate estimation across various markets in solutions deployed locally, close to end users.

Septal Reposition during Intermediate Cleft Rhinoplasty: A Second Chance for Correcting Caudal Septal Deviation.

The authors investigated postoperative nasal morphologic changes in patients undergoing secondary correction of cleft-lip nose with septal repositioning and alar cartilage suspension during preschool age. The authors performed a retrospective review of 77 patients who underwent secondary correction of cleft-lip nose. The patients were 5 to 6 years of age and underwent intermediate rhinoplasty by alar cartilage suspension, with or without septal repositioning. They were divided into 2 groups based on time, encompassing septal repositioning (September of 2015 through November of 2017) and control (November of 2009 through August of 2015) groups. The authors performed a photogrammetric comparison by assessing the postoperative nasal morphologic changes using linear and angular measures. The cleft-to-noncleft-side ratio of each parameter was measured for the nostril width and height, nostril area, and caudal septal deviation angle. Among the 77 patients, 43 were selected as the septal repositioning group and 34 as the control group. Evaluation timing was 5.32 ± 0.45 years of age for the preoperative period (T0), 6.57 ± 0.5 years of age for short-term follow-up (T1), and 9.28 ± 0.65 years of age for long-term follow-up (T2). The septal repositioning group showed significantly improved nostril width ratio and caudal septal deviation angle in the T1 and T2 periods. Septal repositioning significantly decreased the nostril area ratio in the T1 and T2 periods due to decreased cleft-side and increased noncleft-side nostril area. The secondary correction of cleft-lip nose with septal repositioning during preschool age offers a second chance to correct nasal appearance by balancing the nostril symmetry and correcting the caudal septal deviation. Therapeutic, III.

The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft.

The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.

CAMBIOS EN LA VÍA AEREA SUPERIOR POSTERIOR A EXPANSIÓN RAPIDA DEL MAXILAR EN NIÑOS DE 12 AÑOS

Rapid maxillary expansion is often considered the treatment of choice for the correction of maxillary constriction. Several studies highlight the effect of rapid maxillary expansion in increasing nasal length and volume. The aim of this study is quantifying the volumetric changes of the upper airway, the maximum restricted area of the upper airway and the nostrils area, after the intervention of a rapid maxillary expansion using bimaxillary CBCT. A retrospective study was carried out, in which 14 patients of 12 year old with a diagnosis of unilateral or bilateral crossbite and skeletal maxillary constriction were selected. The treatment was carried out with a Mcnamara-type rapid expansion device and 8 mm of disjunction was planned. An initial bimaxillary CBCT was requested and another 15 days after treatment. Measurements were made at the maxillary level, upper airway and the maximum restricted area and the cross section of the nostril area, using 3D measuring softwares. It was obtained that, for every 1 mm of planned disjunction, 0.65 mm of maxillary disjunction is achieved, an upper airway gain of 0.7 cm3, the maximum restricted area gain of the upper airway of 9 mm2 and a gain in the nostrils area of 7.4 mm2 on average. In conclusion rapid maxillary expansion generates a significant increase in the volume of the upper airway and its narrower area

Can the emotional state of calves be noticed by their facial expression and heart rate?

The aim of this study was to identify whether or not dairy calves change their facial expression and heart rate according to their emotional state when subjected to a stroking or umbrella stimulus. Thirty-two mixed-breed Holstein calves of different ages were submitted to stroking and umbrella stimulus. For the stroking stimulation, a researcher performed stroking for 1 min in the neck region with continuous and frequent movements (about 40–60 movements per minute) to simulate the speed with which an animal would receive allogrooming. As for umbrella stimulus, a researcher positioned himself one meter in front of the calf, with an umbrella in his hand, without making eye contact. Then, the umbrella was suddenly opened and remained open for one minute. The eyebrow position, mouth, eye white area, nostril area and heart rate were investigated. For the continuous variables, eye white area, nostril area and heart rate we used the linear mixed effects. For the binary variables, mouth (open or closed) and eyebrow (raised or normal). We used the generalized linear mixed model with logit link function. The variables eye white area, nostril area, mouth and eyebrow did not present significant effects (P > 0.05) as a result of the stimulus. However, the heart rate showed a significant difference (F(1150) = 15.264, P < 0.001) according to the stimulus the animals received. Dairy calves do not express facial changes in their emotional state when subjected to stroking or umbrella stimuli, but there is a reduction in heart rate relates to the valence of a stimulus.

Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study.

The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated. This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods. For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05). Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV. Step Le Fort I advancement surgery technique usually affects nasal structures positively regarding the nasal airway.

Long-Term Outcome of Primary Rhinoplasty with Overcorrection in Patients with Unilateral Cleft Lip: Avoiding Intermediate Rhinoplasty.

No consensus exists regarding the timing or technique of rhinoplasty for correction of the unilateral cleft lip nose deformity, with few studies examining the long-term effects of a single technique. This study appraised the long-term outcomes of primary rhinoplasty using the Tajima technique for overcorrection in a cohort of patients with unilateral cleft lip nose deformity after attaining skeletal maturity. Consecutive nonsyndromic patients with unilateral cleft lip nose deformity ( n = 103) who underwent primary rhinoplasty with overcorrection by a single surgeon between 2000 and 2005 were reviewed. Patients with unilateral cleft lip and nasal deformity who underwent primary rhinoplasty (but with no overcorrection) ( n = 30) and noncleft individuals ( n = 27) were recruited for comparison. Outcomes were assessed through FACE-Q scales evaluating satisfaction with appearance of nose and nostrils (two scales) and computer-based objective photogrammetric analysis of nasal symmetry (nostril height, nostril width, nostril area, alar height, and alar width parameters). Significant differences (all P < 0.001) were observed between the Tajima and non-Tajima groups for all but one photogrammetric nasal parameter (nostril area), with the Tajima group demonstrating closer mean values to the noncleft group. The Tajima and noncleft groups demonstrated no significant difference (all P > 0.05) for scores of FACE-Q nose and nostrils scales. This study indicated that the patients who underwent primary rhinoplasty with overcorrection had improved results with no necessity for intermediate rhinoplasty, emphasizing that the procedure is an effective approach to correct the unilateral cleft nose deformity. Therapeutic, III.

Trigeminal‐mediated headshaking: A diagnostic challenge

Trigeminal‐mediated headshaking: A diagnostic challenge

The Role of Nasal Sill Correction in Secondary Cleft Rhinoplasty.

Evaluating outcomes after cleft rhinoplasty can be challenging because of the lack of objective measures that would lead to a more desirable outcome. This study is a 10-year retrospective review of 30 consecutive patients who underwent secondary unilateral cleft rhinoplasty performed by a single surgeon. Subjective ratings were made using the Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE), which rates 4 components (nose, cupid's bow, lateral lip, and free vermillion) with a score of 0 to 2. Multiple anthropometric measurements (nostril height ratio, width ratio, medial ¼ height ratio, sill ratio, nostril area ratio, columellar angle, tip projection ratio, and nasolabial angle) were taken using a free National Institutes of Health program, ImageJ. Standardized photographs were compared at T0 (preoperatively), T1 (<6 weeks postoperatively), and T2 (>6 weeks postoperatively). There were 30 patients who met our inclusion criteria: 10 males (66.7%) and 20 females (66.7%). Of these patients, 26 (86.7%) had a complete cleft lip and 4 (13.3%) had an incomplete cleft lip. The patients' average age at time of surgery was 16.2 years with a mean follow-up of 17.9 months. Subjective scores in both nasal and overall UCL SOE ratings improved from T0 to T1, 0.7 to 1.2 (P ≤ 0.001) and 3.6 to 4.7 (P ≤ 0.001), respectively. Visual analog scores in nasal and overall UCL SOE ratings improved between T0 and T2, 0.7 to 0.9 (P = 0.023) and 3.6 to 4.8 (P = 0.002), respectively. Of all the objective measures, nasal sill ratio and cleft height to width ratio correlated with improved subjective ratings across multiple time points. Our study shows that objective measures such as nasal sill and nostril shape (cleft height to width ratio) correlate with improved subjective visual analog scale using the UCL SOE. The nasal sill is an often overlooked, yet essential, part of creating an aesthetically pleasing nose during cleft rhinoplasty.

Improving Nasal Symmetry with Alar Composite Graft: Technique and Outcome Assessments in Cleft Patient

PurposeResidual cleft nasal deformities after initial cleft repair can have long-term cosmetic and psychological impact on patients. The authors describe a novel technique of an alar composite graft for patients with cleft lip and/or palate and assess the surgical outcomes with respect to symmetry of individual anatomical components. Materials and methodsThis was a retrospective study of patients with a history of cleft lip/palate who underwent rhinoplasty with alar composite graft placement by the senior author from March 2014 to January 2021. Patients who had high-quality pre-operative and postoperative 3D imaging were included. Patient age, sex, surgical history, cleft side, cleft details, and operative details were recorded. The primary operative technique includes the following: 1) Weir and sill excision at the donor side, 2) composite graft harvest, 3) Weir and sill incision at the recipient side, 4) graft placement, 5) closure of the incision sites. Three-dimensional imaging was obtained pre-operatively and postoperatively using Vectra M3 3D Imaging (Canfield Imaging System, Fairfield, NJ). Linear and surface area measurements were made on donor and recipient sides. The difference in measurements was calculated to analyze the degree of similarity across sides, and this difference was compared pre-operatively to postoperatively.1,2 Symmetry of the patient's nostrils and overall nasal symmetry was compared pre-operatively and postoperatively using root-mean-square deviation (RMSD), with smaller values indicating more symmetry. Differences between preoperative and postoperative measurements were calculated with a paired T-test. ResultsOut of 10 patients undergoing the surgery, 8 were able to be included in this study. On lateral view, the donor and recipient sides were more similar postoperatively compared to pre-operatively with respect to lateral alar-columellar disproportion (1.040 versus 3.324, P = .005) and nostril area (0.466 versus 1.065, P = .001) . On basal view, postoperative results showed more similar measurements comparing the donor and recipient sides in nostril height (1.461 versus 3.542, P = .012), nostril width (0.956 versus 2.222, P = .033), nasal dome height (1.597 versus 3.822, P = .024), and nostril surface area (0.188 versus 0.531, P = .015). On symmetry analysis, the overall external nose was more symmetrical after placement of the alar composite graft (1.094 vs 1.772, P = .015). ConclusionCleft lip and palate can cause significant asymmetry related to the nostrils, ala, and overall appearance of the nose. The alar composite graft is a useful technique to improve symmetry over a wide range of dimensions on lateral, basal, and frontal views.

Using rotation cross-advancement flap for repairing complete unilateral cleft lip and nasolabial deformity

To evaluate the efficacy of rotation cross-advancement flap method in repairing the nasolabial deformity of complete unilateral cleft lip. A retrospective study was performed to analyze the children who were treated by using the rotating cross-advancement flap for repairing the complete unilateral cleft lip at the Fujian Medical University Union Hospital from October 2018 to July 2019. The clinical data such as patient's lip height, lip length, nostril height, nostril width, nostril area and so on were collected at the pre-operation, post-operation and following-up visits respectively and used to evaluate the efficacy of the treatment. Six children were included in the present study. The ratios of lip height on noncleft side to cleft side were 2∶1 at the pre-operation time. The ratios of nostril height on the noncleft side to the cleft side were about 2∶1. The ratios of the width and the area of the nostril were 1∶2 to 1∶3. At the post-operation time, the ratios of length and height of the lip at the cleft side to the noncleft side were around 1∶1. The shape of the nostrils and nasolabial fold were almost symmetrical between the cleft side and noncleft side. The shapes of the nasal sill were acceptable and the postoperative scars were not obvious. There were no obvious incision healing complications and the treatment effects were satisfactory. Rotation cross-advancement flap method was safe and reliable for repairing the nasolabial deformities in children with complete unilateral cleft lip.

Three-Dimensional Computed Tomography Reconstruction and Measurement of Nasal End Deformity in Complete Unilateral Cleft Lip and Palate.

The repair of nasal deformities secondary to cleft lip and palate is complex and requires reliable preoperative nasal 3-dimensional assessment. This study explored nasal end (defined as the lower third of the external nasal and vestibular parts of the nasal cavity) deformities secondary to unilateral complete cleft lip and palate. Three-dimensional nasal end morphometric measurements were obtained from 48 patients who had undergone Millard cleft lip repair and reached skeletal maturity (cleft group) and from 36 age- and ethnicity-matched normal subjects (control group). For the cleft group, paired t tests and 1-way analysis of covariance were used to evaluate the internal and external morphological characteristics of the cleft and noncleft sides of the nasal end, and correlation analysis was done to evaluate the relationship between cleft-side measurements. In the cleft group, the cleft side showed significantly smaller nasal vestibular volume and skin area, nostril area, nasal column length, and nostril height and greater nostril base length and nasal alar length than the noncleft side (all P < 0.05). Controlling for sex, there were significant differences in the nasal vestibular volume and skin area, internal nasal valve area, long nostril diameter, nostril base length, columella length, nostril height, and nasal alar length between the cleft and control groups (all P < 0.05). On the cleft side, the area of the skin lining of the nasal vestibule positively correlated with the alar length (r = 0.67, P < 0.05). Three-dimensional nasal end reconstruction provides a more detailed preoperative nasal end morphological evaluation than previously available techniques. Level III, case-control study.

Assessment of the necessary conditions for robot-assisted surgery in the nasal cavity

Objectives - to determine the necessary conditions for performing robot-assisted operations in the nasal cavity.&#x0D; Material and methods. We have investigated the movement of an endoscope in space by measurements based on high-resolution computed tomography (CT) data. A total of 50 CT scans of the paranasal sinuses were used for this purpose. The tomograms were randomly selected from among the patients of the ENT clinic of the Saratov State Medical University. The main parameters characterizing the movement of the endoscope in the nasal cavity under the conditions set by us are the magnitude of its linear displacement from the entry point and the angle of its deviation, measured in three planes - frontal, sagittal and horizontal, provided that the planes of these sections pass through the entry point during various operations. To control these measurements, we detected the displacements of the endoscope in space using an optical tracking system we made, as well as specialized software designed specifically for the purpose of optical tracking. With the help of this device, measurements were carried out on the skulls and their models, the silicone model for endoscopic examination K. Storz 723128, as well as during real endoscopic operations on the paranasal sinuses. All studies were combined into groups according to the standard protocols of endoscopic operations performed endonasally: Anterior ethmoidotomy, Posterior ethmoidotomy, Frontotomy, Sinusotomy, Sphenotomy, Adenotomy.&#x0D; Results. The main characteristics of the movement of the endoscope in the nasal cavity at a given entry point in the nostril area were established - its maximum linear and angular displacement during various types of FESS interventions for adults.&#x0D; The results obtained by us can serve as the main criteria for the development of a specialized robot assistant that holds and moves the endoscope in space during FESS.

Analysis of the correlation between infrared thermal sequence images of nostril area and respiratory rate

In this study, a thermal imaging instrument was used to obtain facial thermal image information which was then used to calculate the number of breaths taken. However, small movements were inevitable and the first issue addressed was the means by which image calibration and region selection was to be made. To this end, thermal image sequence data calibration was done using technology that resolved small natural deviations in the nostril area. After these problems had been solved, a Hampel filter was used to process the nostril area signals. The independent component method was used to filter the effects of non-respiratory signals, and the least squares method was employed for smoothing. Savitzky-Golay filtering was used to adjust the signal baseline and the processed nostril region thermal image signals were compared with standard abdominal breathing band signals. Results showed that the difference in the number of breaths per minute was less than 1.5 times. The usual normal respiratory frequency range lies within a range of 0.1–0.5Hz. In the calculation of ‘coherence obtained from MVAR model’, the spectral coherence analysis results showed the methods proposed in this study can substantially enhance the relevance between 0.15 and 0.2Hz.

Paranasal Augmentation With Composite Graft Transfer in Overresection of Alar Base and Nostril Contracture.

Many Asian patients desire a narrower nasal base with less flaring of the alar lobules. However, patients who underwent multiple rhinoplasty surgeries with nostril contracture or an overreduction of the alar base may experience nostril contracture and deformity, which may lead to further airway obstruction. We present a technique that combines paranasal augmentation with composite chondrocutaneous graft transfer to overcome this problem. Nine patients underwent composite chondrocutaneous graft transfer to the soft triangle or alar base combined with paranasal augmentation using preshaped porous polyethylene implants to correct nostril contracture and airway obstruction between September of 2014 and May of 2018. Preoperative and postoperative alar base distances and cross-sectional areas of the nostrils were measured and compared. The average thickness of paranasal augmentation was 5.5 mm (range, 4.0-7.0 mm). Eighteen composite grafts were located over the soft triangle (n = 3) and the alar base (n = 15). The average number of composite grafts for each person was 2 (range, 1-4). All composite grafts survived totally or partially, and no graft failed. The average follow-up was 10.9 months (range, 3-28 months). The alar base increased 13.9% (range, 2.2%-23.9%), and the nostril area increased an average of 78.1% (range, 4.5%-316.8%) postoperatively. Patients had satisfactory aesthetic and functional outcomes. Combining paranasal augmentation and composite graft transfer increased the cross-sectional area of the external valve and improved nostril contracture and airway obstruction after the overresection of the alar base or nose contracture after multiple rhinoplasty surgeries.

The Effect of Immediate Versus Delayed Addition of the Nasal Stent to the Nasoalveolar Molding Plate on Nostrils Shape and Cleft Width in Infants With Unilateral Cleft Lip and Palate

The main aim of this study was to evaluate the effect of immediate versus delayed addition of the nasal stent to the nasoalveolar molding plate on the nose shape and alveolar cleft area in unilateral cleft lip and palate infants. Twenty nonsyndromic newborn infants with unilateral cleft lip and palate were scanned 3 dimensionally using Proface software. In the experimental group, the nasal stent was added on the day the molding plate arrived, and in the control group when the alveolar gap reached 5 mm. Two months after adding nasal stents in each group patients' faces were scanned again and some parameters were measured. In addition, immediately after treatment, 1 month later and at the end of investigation, impressions were taken, and stone casts were scanned by cone-beam computed tomography and the alveolar gap was measured. Fisher exact test, paired t test, and ANOVA were used for data analyses. P < 0.05 was considered as significant. In this study, changes in the parameters showed significant differences between the case and controls for the columellar angle, nostril width on the cleft side, nostril height on the cleft side, soft tissue cleft width, and nasal surface area. However, the nostril's width and height in the noncleft side, intercommissural distance, nasal surface area on the noncleft side, nostril area between the cleft and noncleft side after treatment, and the alveolar gap did not show significant differences between the groups (P > 0.05). Early use of nasal stents showed more desirable results in decreasing the width of the nostrils and increasing its height and correcting the angle of the columella without any adverse effects on the nostrils after treatment.

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

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