Nostril Asymmetry Research Articles

Aesthetic and Functional Results of Lateral Crural Repositioning.

Thin or cephalically malpositioned lateral crura cause nasal obstruction by depressing nasal valves and decrease patient satisfaction with rhinoplasty as a result of nostril asymmetry and alar collapse. To demonstrate the aesthetic and functional efficacy of lateral crural repositioning with lateral strut grafting in patients with cephalic malposition of the lateral crura undergoing primary septorhinoplasty. We prospectively selected 80 patients with lateral crural malposition who underwent primary septorhinoplasty performed by the same surgeon from December 1, 2013, through May 30, 2014. The surgeon measured the angle between the lateral crura and midline intraoperatively with a goniometer to confirm malposition (angle, ≤30°). Data analysis was performed from March 13 to 23, 2015. All the patients underwent primary rhinoplasty with the open approach. Lateral crural repositioning with lateral crural strut graft was used in all selected patients. Preoperative and 6- and approximately 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation (NOSE) scale (range, 0-20; decreased scores indicate improved functional results) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range, 0-24; increased scores indicate improved aesthetic results). Seventy-five of 80 patients were confirmed to have cephalic malposition intraoperatively. Four patients were excluded owing to selection of different surgical techniques, leaving 71 patients for analysis. The mean (SD) and median postoperative NOSE scores at 6 months (3.18 [3.12] and 2.0) and 12 months (0.39 [1.07] and 0) showed significant improvement compared with the preoperative scores (6.96 [5.10] and 7.0) (P < .01 for each comparison). The mean (SD) and median postoperative ROE scores also showed significant improvement at 6 months (21.06 [3.82] and 23.0) and 12 months (23.12 [2.09] and 24.0) compared with preoperative scores (7.03 [3.70] and 6.0) (P = .001). However, the changes from preoperative to 12-month postoperative scores (mean [SD] and median) were not significantly different between patients with normal (NOSE scores, 8.41 [4.59] and 90 to 0.28 [0.79] and 0, respectively; ROE scores, 6.97 [3.24] and 6.0 to 23.31 [1.91] and 24.0, respectively) and thin (NOSE score, 6.59 [5.09] and 8.0 to 0.11 [0.33] and 0, respectively; ROE scores, 7.76 [3.82] and 7.0 to 23.29 [1.72] and 24.0, respectively) skin types and those with thick skin types (NOSE scores, 5.52 [5.42] and 4.0 to 0.72 [1.54] and 0, respectively; ROE scores, 6.60 [4.16] and 6.0 to 22.80 [2.53] and 24.0, respectively) (P > .05). Lateral crural repositioning is a useful and versatile technique to achieve successful functional and aesthetic results in a 1-year follow-up. We detected no significant difference by skin type in improvement of nasal function and aesthetic satisfaction. 3.

Presenting concerns and surgical management of secondary rhinoplasty.

Secondary rhinoplasty is a challenging surgical procedure, and patients seeking this procedure tend to be difficult to please. However, psychological and functional improvements in patients and high satisfaction rates are achievable with secondary rhinoplasty. The authors reviewed a series of secondary rhinoplasties and tabulated patient concerns, underlying deformities, and corrective surgical procedures. The authors conducted a retrospective review of 109 patients for whom the senior author (B.M.) performed secondary rhinoplasty from 2009 to 2012. Concerns causing the patients to seek surgery and management of the secondary procedures were described. The mean patient age at time of surgery was 33.2 years (range, 18-61 years), and most patients (71.6%) were women. The mean number of previous procedures was 1.6 (range, 1-8). Chief presenting concerns were asymmetry (36.7%), large tip (24.8%), and breathing difficulties (22.0%). The most common clinical findings were nostril asymmetry (33.9%), septal deviation (32.1%), overresection (26.6%), and tip asymmetry (26.6%). Patients seeking secondary rhinoplasty present with various concerns. Preoperative identification of the underlying problems and determination of the techniques required to correct them are important to successful secondary procedures. LEVEL OF EVIDENCE 4: Therapeutic.

Effect of septoplasty with a caudal septal batten graft on changes in nasal shape.

This study aimed to determine frequency of external nasal deformities in patients with deviated septa and the effect of endonasalseptoplasty with batten grafting on the external nasal appearance. The 52 patients who underwent endonasalseptoplasty with a batten graft for the correction of caudal septal deviations were included in the study. The preoperative and postoperative photographs of 52 patients were reviewed retrospectively. Gross changes (nasal deviation, dorsal middle vault height, tip height change, and nostril asymmetry) were assessed. Anthropometric measurements (dorsal height, nasal tip projection, nasolabial angle, nasofrontal angle, and deviation angle) were performed. Preoperative assessment showed that 71% of the 52 patients had deformities, including nasal deviation (n=28), hump nose (n=19), saddle nose (n=3), and nostril asymmetry (n=15). On postoperative analysis, favorable changes in dorsal deviations were seen in 61% of patients. There were no aesthetic changes for hump or saddle nose deformities, whereas nostril asymmetry was corrected in 20% of patients. Anthropometric measurements also showed that dorsal deviation angles were corrected after surgery (P<.05), whereas other parameters showed no significant changes. In selected cases, deviated noses can be corrected to some extent by septoplasty with caudal septal batten grafting.

Late presenting nasal deformities after nasal continuous positive airway pressure injury: 33-year experience

This study was designed to characterize the resultant nasal deformities seen in adolescent and adult patients who sustained nasal continuous positive airway pressure (nCPAP) injuries during their NICU admission. Data from patients who sustained nCPAP injury in the NICU and seen for plastic surgery evaluation at one institution over the past 33 years was collected. Exclusion criteria were patients with additional nasal trauma after nCPAP injury. A retrospective review was performed, including demographics, time of initial injury, surgical timing, associated medical history, nasal function and photographs. Deformities were characterized according to aesthetic nasal subunit location and secondary nasal deformities. Outcome measures included the need and type of surgical correction, presence of airway obstruction, and surgical complications. 11 patients were included; the average age was 13.9±4.6 years. The average gestational age was 26.5±1.6 weeks. All of the nasal deformities included the inferior third of nose. The nasal soft triangle and columella were the most common subunits affected. Three patients had combined deformities with involvement of at least two nasal subunits. All injuries resulted in secondary nasal deformities, including nostril asymmetry, columellar asymmetry, nasal tip deviation, lack of projection and nasal airway obstruction. All patients required at least two operative interventions for treatment. Mean age of initial reconstruction was 7.2 years. Despite surgical intervention, secondary deformities and nasal airway obstruction was still present. Late presenting nCPAP injury deformities most commonly affect the lower third of the nose and can result in a myriad of secondary nasal deformities. The nasal soft triangle and columella were the most commonly involved subunits. Secondary deformities involved the nasal aesthetic subunits adjacent to the primarily affected areas, resulting in asymmetry as well as nasal airway obstruction. Most patients required staged open nasal reconstruction with composite grafts.

Nostril Morphometry Evaluation before and after Cleft Lip Surgical Correction: Clinical Evidence.

Introduction The purpose to this work is to review systematically the morphological changes of the nostrils of patients undergoing surgery for correction of cleft lip and identify in the literature the issues involved in the evaluation of surgical results in this population. Review of Literature A review was conducted, searching for clinical evidence from MEDLINE. The search occurred in January 2012. Selection criteria included original articles and research articles on individual subjects with cleft lip or cleft palate with unilateral nostril anthropometric measurements before and after surgical correction of cleft lip and measurements of soft tissues. There were 1,343 articles from the search descriptors and free terms. Of these, five articles were selected. Discussion Most studies in this review evaluated children in Eastern countries, using different measurement techniques but with the aid of computers, and showed improved nostril asymmetry postoperatively compared with preoperatively. Conclusion There is a reduction of the total nasal width postoperatively compared with preoperative measurements in patients with cleft lip.

Frequency of the Preoperative Flaws and Commonly Required Maneuvers to Correct Them

The purpose of this study was to identify the most common deformities seen preoperatively in secondary rhinoplasty patients and the required surgical maneuvers to correct them. A retrospective chart review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included demographics, prior rhinoplasty data, main aesthetic/functional concerns, and the senior author's physical examination of the nose. Details of the operative maneuvers were reviewed. The average patient age was 39.2 years. All patients had previous rhinoplasties performed by other surgeons. The most common preoperative complaints were airway occlusion (65 percent), dorsum asymmetry (33 percent), nostril asymmetry (18 percent), and tip asymmetry (14 percent). The most common preoperative nasal deformities seen by the senior author (B.G.) were dorsal asymmetry (65 percent), wide dorsum (47 percent), nostril asymmetry (41 percent), wide alar base (38 percent), and dorsal hump (30 percent). The senior author saw significantly more nasal deformities than the patients themselves, especially in the following areas: dorsal asymmetry (65 percent versus 33 percent; p = 0.0002), wide dorsum (47 percent versus 13 percent; p < 0.0001), nostril asymmetry (41 percent versus 18 percent; p = 0.0003), wide alar base (38 percent versus 6 percent; p < 0.0001), dorsal hump (30 percent versus 9 percent; p < 0.0001), and columella protrusion (25 percent versus 6 percent; p = 0.0002). The most common revision rhinoplasty surgical maneuvers were septoplasty (71 percent), alar rim graft (67 percent), dorsal graft (63 percent), osteotomy (60 percent), and dorsal hump removal (46 percent). The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty. There is often a disparity between what the patient sees and what the surgeon observes.

Reconstruction of composite defects of the nose following tumor resection — a single author’s experience and evaluation of the outcome

The aim of the study was to present our experience in reconstruction of complex defects of the nose. Fourteen patients presenting with large composite defects of the nose were anatomically reconstructed after full tumor clearance of a skin cancer. The aesthetic outcome was assessed subjectively and objectively while the functional outcome was only assessed subjectively in 13 patients. Basal cell carcinoma (BCC), represented the tumor excised in 10 patients while the remaining 4 patients suffered from squamous cell carcinoma (SCC). One patient died of extensive local recurrence of SCC after 6 months. The commonest flap used for inner lining was the septal flap while the forehead paramedian flap provided the external coverage for the majority of patients. All flaps survived completely except in one patient who developed distal paramedian forehead flap necrosis. Two patients developed multiple abscesses and sinuses discharging parts of cartilage grafts through the flaps’ skin with one patient suffering from total extrusion of the costal cartilage grafts. Two other patients suffered from severe nostril stenosis. All patients had variable degree of difficulty in airway passage, while most patients were satisfied with the total nasal appearance. The objective assessment of the overall appearance of the nose scored less than the subjective satisfaction. Reconstruction of complex nasal defects has a high learning curve. Intranasal flaps are usually of limited size and nostril asymmetry is likely to occur. Local or regional skin flaps if available are still considered a good choice for inner as well as outer lining.

Treatment outcomes of pediatric rhinoplasty: The Asan Medical Center experience

ObjectivePerforming rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger. MethodsThe study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1=satisfied, to 4=dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively. ResultsRhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation. ConclusionsThe outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.

Surgical Considerations in Secondary Rhinoplasty for Effective Correction of an Asymmetric Nostril

Asymmetric nostrils that develop after rhinoplasty may result in nasal tip deformity and result in patient dissatisfaction. No systemic study on methods for the correction of transformed nostrils has been reported. In the current study, asymmetric nostrils were classified according to the degree of asymmetry and the authors' experiences on the correction of nostril deformities are described. Thirty-nine patients who experienced asymmetric nostrils after primary rhinoplasty were selected for the current study. Nostril asymmetry was classified as types 1 to 3. All patients underwent secondary rhinoplasty, and 3-dimensional total alar cartilage dissection and reposition were performed on most patients. Patient satisfaction was assessed using a 5-level index. Of the 39 patients, 10 were classified as having asymmetry type 1; 13, asymmetry type 2; and 16, asymmetry type 3. The mean follow-up period after the secondary rhinoplasty was 17 months. Of the 39 patients, a total of 34 showed improvement in asymmetry after the surgery. Of the remaining 5 patients, 3 patients showed incomplete correction and 2 patients showed deteriorated asymmetry. In the patient satisfaction survey, 31 of the 39 patients answered "somewhat satisfied" or "very satisfied." Before the correction of asymmetric nostrils that developed after primary rhinoplasty, the cause of the asymmetry should be analyzed and appropriate procedures should be selected. Three-dimensional total alar cartilage dissection and reposition are both useful methods for the correction of alar cartilage asymmetry.

Prevalence of Occult Nostril Asymmetry in the Oversized Nasal Tip

To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program. We performed a retrospective observational study in a private practice, ambulatory care setting. The photographs of 100 randomly selected patients undergoing rhinoplasty who presented with excessive nasal tip width and no apparent nasal base asymmetry were evaluated for occult nostril asymmetry. Patients varied by ethnicity and sex and ranged in age from 16 to 40 years. We excluded patients with discrete nasal base asymmetry, crooked or twisted noses, caudal septal deviation, columellar tilt, a history of craniofacial trauma, or a history of nasal surgery. Measurements were obtained using a standard photographic analysis program. On the basal view, the median percentage of asymmetry (95% confidence interval) was 4.91% (4.17%-5.66%); on the frontal view, 4.66% (3.68%-5.62%). On the basal view, 73% of noses were at least 2.5% asymmetric; on the frontal view, 67% (McNemar P = .53). On the basal view, 48% of noses were at least 5% asymmetric; on the frontal view, 50% (McNemar P = .74). On the basal view, 11% of noses were at least 10% asymmetric; on the frontal view, 20% (McNemar P = .11). A large percentage of individuals presenting with excessive nasal tip width and no obvious alar size discrepancies have nasal base asymmetry. Moreover, nostril asymmetry is demonstrated from the frontal and basal views with reasonable consistency. In a small subset of study patients, occult nostril asymmetry exceeded 10% of the total nasal base width. We postulate that clinically significant nostril size discrepancies are hidden by excessive tip width, and we speculate that these nostril size discrepancies become more apparent after surgical refinement of the oversized nasal tip, thereby potentially leading to unexpected postoperative cosmetic imperfections and patient dissatisfaction. The apparent frequency of (occult) nostril asymmetry in patients with excessive nasal tip width underscores the importance of nostril size assessment in the preoperative aesthetic analysis. We offer a reliable and convenient method for objective analysis of nasal base symmetry.

Prevalence of Occult Nostril Asymmetry in the Oversized Nasal Tip

Objective To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program. Methods We performed a retrospective o...

The Lip-to-Tip Flap: A Method of Reconstructing Nasal Tip Defects

Sir: We report a case of a congenital cleft of the left alar rim that could not be classified using any of the schemes used to name facial clefts. An 8-month-old girl born with a nasal cleft after 37 weeks’ gestation was referred to the Yale Craniofacial Center for evaluation of this deformity (Fig. 1). The decision to repair the cleft was made using a combination of Z-plasty internally along the nasal vestibule/nasal tip and a bifurcation of the flap on the external surface to minimize scarring externally. The patient presented with minimal notching of the alar rim 15 months postoperatively (Fig. 2).Fig. 1.: Preoperative oblique (above) and (below) caudal views of the nasal cleft. Note the full-thickness alar cleft extending from the free border of the alar rim, the nostril asymmetry with a narrowed nostril of the affected side, and the asymmetry of the columella.Fig. 2.: Appearance at 15-month follow-up. (Above) Frontal view of alar rim (and associated notching); (below) left lateral view.Although nasal development is complicated, congenital anomalies are rare, with an incidence of one in every 20,000 to 40,000 live births.1 Despite a variety of schemes to classify facial clefts, the most commonly used is Tessier’s classification. This classification is based on rigid axes that often prove problematic in naming wide-spanning clefts.2 The continuity and the complexity of this cleft suggest that it belongs to what Tessier dubbed “‘renegade’ compound malformations [that] defy classification by the framework” he had proposed. The embryonic appearance of the stomodeum between the fourth and fifth weeks of gestation commences the external development of the nose.3 The neural crest cells, which are the developmental precursors of the nose, begin migrating caudally from the lateral aspects of the frontal prominence to the midface.4 The proliferation of the neural crest cells results in the formation of the nasal placodes which, when covered by ectoderm, transform into the olfactory pits. The invagination of the olfactory pits gives rise to the sides of the nose, the septum, philtrum, and premaxilla of the nose. The globular processes grow posteriorly, becoming the nasal laminae.3 The nasal laminae fuse with the nasofrontal process, forming the nasal septum. The globular processes fuse with the maxillary processes, creating the philtrum and columella. The maxillary processes form the lower region of nasal cavity’s lateral walls and the nares’ posterior portion. We hypothesize that in the fourth and fifth weeks of gestation, the nasal placode and olfactory pit developed aberrantly. The left nasal placode invaginated atypically, creating a gap on the lateral aspect of the placode. Consequently, the mesenchymal nasal ridge lined with ectoderm did not elevate correctly, forming a region in the olfactory pit that was missing the precursors for cartilage and skin. As this olfactory pit invaginated, the gap continued obliquely in a caudal-posterior fashion, creating this cleft. Because the gap had neither mesenchymal nor ectodermal tissue, the patient experienced a full-thickness cleft. Nasal cleft repair in the pediatric population must be guided by the following three principles: creation of a volume with lining, support, and cover; conservation of an adequate airway; and aesthetic incorporation into the face.5 Because no single method has been proven to be the standard of care in pediatric nasal reconstruction, the surgeon must possess thorough knowledge of the various techniques available to select the correct intervention for each child. Anup Patel, B.S. Bianca I. Knoll, M.D. John A. Persing, M.D. Section of Plastic and Reconstructive Surgery Yale University School of Medicine New Haven, Conn. DISCLOSURE None of the authors has a financial interest to disclose in relation to the content of this article.

Isolated congenital absence of the left lower lateral cartilage

Introduction: Congenital defects of the nasal cartilaginous skeleton are rare, yet clinically relevant, entities that are important to recognize prior to operative repair Methods: A 47 year old woman was referred to our institution for lifelong leftsided nasal airway obstruction. On physical examination, a complete absence of the left lower lateral cartilage was suspected. Hypothesis: Complete congenital absence of the lower lateral cartilage Results: External approach rhinoplasty confirmed the above hypothesis, and reconstruction was performed with autologous septal cartilage. Conclusions: Careful history and physical examination is important in preoperative planning of nasal surgery. External rhinoplasty approach Isolated complete absence of left lower lateral cartilage identified (Figure 2a) Septal cartilage harvested Septal extension graft replaced the left medial crura Lateral crural strut graft replaced the left lateral crura Shield graft to orient and help reconstitute the tip Left domal onlay graft to emphasize left tip highlight Patient pleased with functional and aesthetic outcome Surgical Approach and Results 1. Losee JE, Kirschner RE, Whitaker LA, et al. Congenital nasal anomalies: a classification scheme. Plast Reconstr Surg 2004;113:676-689. 2. Bilkay U, Tokat C, Ozek C. Reconstruction of congenital absent columella. J Craniofac Surg 2004;15(1): 60-63. 3. Mavili ME, Akyurek M. Congenital isolated absence of the nasal columella: reconstruction with an internal nasal vestibular skin flap and bilateral labial mucosa flaps. Plast Reconstr Surg 2000;106(2):393 -399. 4. Yilmaz MD, Altunas A. Congenital vomeral bone defect. Am J Otolaryngol 2005;26(1):64-66. 5. Klinger M. Caviggioli, Klinger F, et al. Isolated congenital absence of the nasal bones and aesthetic surgical correction: managing and case report. Aesth Plast Surg 2005;29(4):246-249. References 47 year old otherwise healthy Latin American female Lifelong left sided nasal airway obstruction No prior facial trauma or surgery Exam showed mild septal deviation, profound nostril asymmetry, and the absence of any palpable cartilage within left side of the nasal tip (Figure 1) Case Presentation Figure 2a. Complete absence of lower lateral cartilage on the left. Figure 2b. Surgical repair with septal extension, lateral crural strut, and domal onlay grafts. Isolated, non-syndromic cases of absent nasal structures is exceedingly rare. No previous reports exist of isolated absence of a lower lateral cartilage. May occur after fusion of mesenchymal components by 10th week of gestation from vascular accident or pressure phenomenon. Despite its rarity, this anomaly reinforces the importance of careful pre-rhinoplasty analysis and familiarity with principles of open structure rhinoplasty. Conclusions Introduction History and physical examination are crucial to appropriate pre-operative planning of functional and cosmetic rhinoplasty Externally, special attention is paid to the characteristics of the skin-soft tissue envelope, the nasal bones, middle nasal vault, and the lower lateral cartilages. Internally, examination of the septum, the internal and external nasal valves, nasal sidewalls, inferior turbinates and the nasal mucosa. Congenital anomalies of the nose can be responsible for nasal airway obstruction and are present in 1/20,000 to 1/40,000 births Figure 1. Asymmetry of external nose noted with basal and frontal views.

Custom made alar stents for nostril stenosis: a 24-month evaluation

Nostril stenosis is an uncommon deformity and its aetiology is variable. The shape alteration and nostril asymmetry may have negative aesthetic and functional effects on nostril stenosis patients. Five patients were included in this study and followed up for 24 months; four of these had congenital nostril stenosis and one had an acquired deformity. Alar stent dilators were constructed from measured diameter of the affected nostril/s. The congenital nostril stenosis patients initially received a customised chairside soft nasal dilator ( CCSND), which were later replaced with a customised laboratory rigid nasal dilators ( CLRND). Treatment outcomes were evaluated using a questionnaire and a visual analogue scale to assess improvements in nostril breathing, comfort, appearance and satisfaction of the treatment provided by both types of dilators. There was improvement in nostril diameter with an average expansion of 7 mm and this was stable at the desired diameter. The overall number of stents used to expand the tissues to the desired dimension ranged from 3 to 8 stents. Alar stent therapy is a conservative method to expand nostril tissues and has successfully maintained the nostril diameter for both acquired and congenital stenosis. This improvement in all parameters and the patients’ satisfaction would make the custom-made nostril dilator in particular the CLRND a satisfactory treatment modality for congenital and acquired nostril stenosis.

Correction of Severe Secondary Cleft Lip Nasal Deformity Using a Composite Graft: Current Approach and Review

In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.

Video-Imaging Assessment of Nasal Morphology in Individuals With Complete Unilateral Cleft Lip and Palate

Abstract Objective: The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology. Design: This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle. Results: All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, late...

Video-imaging assessment of nasal morphology in individuals with complete unilateral cleft lip and palate.

The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology. This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle. All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, lateral offset, I11, and I22 were more asymmetric in the cleft group. In the control group, the right nostril was more elliptical and had a greater perimeter, and the left-side nostril had a greater bulkiness (enfolding). The method developed was validated for assessment of nasal morphology in cleft and noncleft samples. Nostril morphology was asymmetric in both groups but more asymmetric in the cleft group than the control group. The dominant influence of the cleft resulted in more elliptical noncleft nostrils and greater nostril shape asymmetry in the cleft group. The validated video-imaging method can now be used to assess the efficacy of treatment on nasal morphology.