Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

Abstract

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

Outcome of facial contour asymmetry after conventional two-dimensional versus computer-assisted three-dimensional planning in cleft orthognathic surgery

“…For appraisal of facial contour asymmetry outcomes, two varieties of facial soft tissue images were employed in patients and normal individuals. Pre-and post-OGS standardized 3D facial images acquired using the 3dMD system (3dMD LLC, Atlanta, GA, USA) under standard conditions (a permanent installation with fixed ambient lighting and system and fixed individual positioning, including individuals with a natural head position, relaxed facial positioning, a closed mouth, and a thin elastic nylon cap to keep the hair away from the face) 34,35 were used for objective assessment of 3D-based facial contour asymmetry analysis with quantitative and qualitative appraisal of data.…”

“…As this finding has widely been demonstrated for normal populations 34,46 , valid deductions could be made from normal-related comparisons. Different from mid-face or nasolabial measurement-based outcome investigations 35,36,47 , in this study we addressed particularly the lower face region. In the literature, facial asymmetry is frequently observed in patients with skeletal Class III malocclusion, with the lower face representing the main anatomical site for presence of asymmetries compared to upper and middle face regions [1][2][3] .…”

“…In our study, the normal individuals had significantly lower RMSD and higher FDI values than OGS-treated patients in the pre-OGS period, regardless of tested group. Therefore, in addition to the typical cleft-associated nasolabial asymmetric deformity 35,36,47 , the lower third of the face appears [12][13][14] to be an additional leading factor in facial asymmetry in patients with unilateral cleft lip and palate.…”

“…Historically, the facial asymmetry was mainly appraised using 2D radiograph or photography-guided landmark comparisons [21][22][23] . However, these tools may have underestimated the spatial 3D composition of the face, a complex structure with distinct anatomical components and contours [34][35][36] . Nowadays, 3D photogrammetry is considered an especially preferred tool for facial soft tissue analysis [34][35][36] .…”

“…However, these tools may have underestimated the spatial 3D composition of the face, a complex structure with distinct anatomical components and contours [34][35][36] . Nowadays, 3D photogrammetry is considered an especially preferred tool for facial soft tissue analysis [34][35][36] . We are not aware of any comparative study of 2D and 3D planning modalities focused on soft tissue-based facial contour asymmetry outcome analysis using 3D photogrammetric tool.…”