3D Analysis of the Unilateral Cleft Lip Nasal Deformity From Initial Morphology to Alterations with Surgery and Time
Raymond Tse, MD, Ezgi Mercan, PhD.
Seattle Children's Hospital, Seattle, WA, USA.
Objective longitudinal analysis of the unilateral cleft lip nasal deformity is critical to optimize cleft care. The purpose of this study was to assess initial nasal morphology and longitudinal changes through surgery and growth.
Consecutive patients undergoing primary cleft lip repair and foundation-based primary rhinoplasty (N=102) were assessed using 3D images captured pre-op, post-op, and at 5 years. Images of age-matched controls (N=73) were used for comparison. Facial meshes were normalized to standard axes and rotation for traditional anthropometric analysis and 4 shape-based morphometric measures.
Prior to surgery, subnasale had the greatest deviation from midline of any landmark (4.6mm). The non-cleft subalare was displaced lateral (2.3mm) whereas the cleft subalare was normal in position but retrodisplaced (1.6mm). Regression analysis using deviation of subnasale from midline as dependent variable revealed progressive lateral displacement of non-cleft subalare, narrowing of non-cleft nostril, posterior displacement of cleft subalare, and intercanthal widening (p<0.02). Subnasale deviation was also associated with progressive abberations in all shape-based measures of nasal form (p<0.02). Surgery corrected nasal base displacements along all axes resulting in landmark positions similar to controls. At 5 years, the symmetry of nasal base correction persisted (including correction of cleft alar base retrusion), however, subjects with clefts had nasal base widening and reduced projection relative to controls.
Contrary to current concepts, the non-cleft side of the nose is displaced lateral whereas the cleft side is retruded. Alar base malposition can be corrected at primary repair and maintained at 5 years.
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