Columella Elongation Surgery Outcome in Complete Bilateral Cleft Lip and Palate

Abstract

Background: The evaluation of surgical outcomes is needed to achieve excellence in nasal reconstruction of patients with complete bilateral cleft lip and palate (BCLP). The study objective is to evaluate the quality of nasal aesthetics after the columella elongation surgery. Methods: The sample of this study consisted of 70 patients with complete BCLP, operated on columella elongation surgery and analyzed at 6 to 12 years. The system for evaluation of nasal appearance after the columella elongation surgery was performed by objective and subjective analyses. Anthropometric Measurements: Four anthropometric nose measurements were performed directly on the faces, and the same was performed in control group (60 children without oral clefts), paired by age and sex with the experimental group. The measurements were repeated 3 times (triplicate). Subjective Analysis: Scores to evaluate nasal width, nasal tip projection, and length of the columella were applied before and after the columella elongation surgery by 5 raters from the rehabilitation team. Interrater and intrarater agreement was calculated by means of the kappa test. Results: Nasal width in BCLP group was higher when compared to the control group ( P < 0.05). Nasal tip projection (subnasal–pronasal) and columella length (subnasal–columella) were decreased in BCLP group compared to that of the controls ( P < 0.05). Columella width was similar in both study groups ( P > 0.05). All scores of nasal aesthetics significantly improved after the columella elongation surgery. Conclusions: Nose of the patients with BCLP is wider, is less projected, and has the shorter columella compared to that of the noncleft subjects. After secondary columella elongation surgery in BCLP, nasal width, nasal projection, and columella length significantly improved.

Three-Dimensional Analysis of Bilateral Cleft Lip and Palate Nasal Deformity

“…Previously, at our center, columella lengthening surgery was routinely performed at the time of alveolar bone grafting. This resulted in 54% of the patients in the 10 years and 15 years’ time points having undergone columella lengthening surgery which likely contributed to added columellar length observed at the 10 and 15 years’ time points (Meazzini et al, 2010; Broll et al, 2019). Unfortunately, we did not have 3D images from before and after columellar lengthening surgery to assess the immediate and long-term effect of the procedure on columella length.…”