A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

Nasolabial Morphological Changes Post-Khon Kaen University Presurgical Nasoalveolar Molding Therapy in Infants with Complete Unilateral Cleft Lip and Palate

ObjectiveTo assess the efficacy of Khon Kaen University presurgical nasoalveolar molding (KKU PNAM) by evaluating nasolabial morphological changes in patients with complete unilateral cleft lip and palate (UCLP) using three-dimensional (3D) anthropometric measurements and comparing nasal morphology to age-matched noncleft controls.DesignA retrospective case series of infants with complete UCLP who underwent KKU PNAM therapy. Patients with complete 3D stereophotogrammetric records at initial (T0) and pre-cheiloplasty (T1) visits were included.SettingKhon Kaen University Cleft Lip and Palate CenterPatients/ParticipantsSixteen infants with complete UCLPInterventionsKKU PNAMMain Outcome MeasuresAnthropometric measurements of nasolabial tissue of infants with complete UCLP were compared between pre- (T0) and post-PNAM treatment (T1) and against age-matched noncleft controls at both time points.ResultsFrom T0 to T1, cleft-sided nostril height and columellar length, height, and angle increased significantly (0.85 mm, 0.83 mm, 1.54 mm, and 17.38 degrees, respectively). Conversely, cleft-sided nostril width, deviated alar base and columella, and vermilion gap significantly decreased (1.57, 1.04, 0.68, and 4.19 mm, respectively). The difference of nostril width and height between cleft and noncleft side was decreased. At T0, alar base, subnasal, and nostril width, alongside the nostril and columellar height, differed from those of control infants. At T1, the columellar height in the treatment cohort was comparable to that of the control. Other parameters remained significantly different; however, these differences decreased post treatment.ConclusionsKKU PNAM therapy improved nasolabial morphology and symmetry in patients with UCLP, suggesting its potential to facilitate successful future cheiloplasty.

Featuring growth of the external nose among patients with congenital cleft anomalies

Cleft lip and palate deformities are usually accompanied by abnormal external nasal morphology which seriously affects facial aesthetics and quality of life. In-depth understanding of the growth pattern of external nasal morphology in patients with cleft lip and palate is essential for deciding the optimal timing of surgical intervention and for furthering improvements in surgical technique. In this review we systematically depict the cross-sectional changes in external nose morphology during growth in the normal population and in patients with clefts, and summarise the iatrogenic impacts on growth of the cleft nose, aiming to provide a reference to further improve the management of the nose in patients with clefts.

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

OBJECTIVE

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.

DESIGN

Descriptive clinical study with one group, prospective.

SETTING

Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam.

PATIENTS

31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery.

INTERVENTIONS

Interventions include PNAM and cheiloplasty by modified Millard technique.

MAIN OUTCOME MEASURES

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.

RESULTS

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).

CONCLUSION

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.

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.

Surgical design and application of alar cartilage positioning and repositioning in correcting cleft lip nose deformity

Correction of nasal deformity is integral to modern cleft lip repair, and high risk of postoperative relapse remains a technical hurdle to overcome. The authors previously presented internal fixation of alar cartilage based on Chinese nasal morphology and lateral columella tissue increment for the correction of unilateral cleft nose deformity. Through the application and review of these techniques, the authors developed a new technique named alar cartilage positioning for primary cleft nose correction, or alar cartilage repositioning for secondary cases. Here, we introduce the theoretical foundation and preliminary experience in using this new technique.