An anatomical study of the three-dimensional structure of the nasal septum in patients with alveolar clefts and alveolar-palatal clefts (original) (raw)
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Three-Dimensional Nasal Morphology in Cleft Lip and Palate Operated Adult Patients
Annals of Plastic Surgery, 2003
Nasal morphology was assessed three-dimensionally in 18 cleft lip and palate operated patients aged 19 to 27 years, and in 161 sex-and age-matched control subjects. Comparisons were performed by Student t and Watson-Williams' tests. No differences were found in nasal volume or surface. Nasal width, alar base width, and inferior width of the nostrils were significantly larger in male patients than in the reference men. The nasal bridge was shorter. Similar differences were found in the female patients. In addition, the right nostril was larger and the nasal height shorter. In men, the nasolabial and the nasal tip angles were smaller in the patients than in the reference subjects, whereas the facial convexity angle was larger in the patients. In conclusion, the nose of adult operated cleft lip and palate patients differed from that of normal control subjects. Surgical corrections of the cleft lip and palate failed to provide a completely normal appearance. The methods might be used to indicate where additional procedures might be performed to approximate a reference population. No significant differences between CLP patients and the normal reference (Student t test for independent samples; 78 degrees of freedom), P Ͼ0.05.
Nasal Airway and Septal Variation in Unilateral and Bilateral Cleft Lip and Palate
Cleft lip and palate (CLP) affects the dentoalveolar and nasolabial facial regions. Internal and external nasal dysmorphology may persist in individuals born with CLP despite surgical interventions. 7-18 year old individuals born with unilateral and bilateral CLP (n 5 50) were retrospectively assessed using cone beam computed tomography. Anterior, middle, and posterior nasal airway volumes were measured on each facial side. Septal deviation was measured at the anterior and posterior nasal spine, and the midpoint between these two locations. Data were evaluated using principal components analysis (PCA), multivariate analysis of variance (MAN-OVA), and post-hoc ANOVA tests. PCA results show partial separation in high dimensional space along PC1 (48.5% variance) based on age groups and partial separation along PC2 (29.8% variance) based on CLP type and septal deviation patterns. MANOVA results indicate that age (P 5 0.007) and CLP type (P 0.001) significantly affect nasal airway volume and septal deviation. ANOVA results indicate that anterior nasal volume is significantly affected by age (P 0.001), whereas septal deviation patterns are significantly affected by CLP type (P 0.001). Age and CLP type affect nasal airway volume and septal deviation patterns. Nasal airway volumes tend to be reduced on the clefted sides of the face relative to non-clefted sides of the face. Nasal airway volumes tend to strongly increase with age, whereas septal deviation values tend to increase only slightly with age. These results suggest that functional nasal breathing may be impaired in individuals born with the unilateral and bilateral CLP deformity. Clin. Anat. 00:000-000,
Cartilaginous septum deviation in children with cleft lip, alveolus and palate – an MRI analysis
Journal of Cranio-Maxillofacial Surgery, 2006
This study aimed to investigate by MRI examination the degree of deviation of the cartilaginous septum in relation to cleft size in patients with cleft lip, alveolus and palate. Material and methods: Six children with cleft lip, alveolus and palate at age 5-20 days were examined with a 1.0 Tesla scanner using a head coil. The following parameters were evaluated: maximal cleft size (millimeter) and degree of the nasal septum deviation from the median-sagittal plane (degrees). Results: Two children with bilateral clefts had no deviation; 3 children with unilateral (left-sided) cleft had a deviation to the right and 1 patient with a unilateral right-sided cleft a deviation to the left side. In all 4 patients, the degree of the nasal septum deviation increased with cleft size. Conclusion: Cartilaginous nasal septum deviation was noticed only in patients with unilateral cleft lip and palate toward the non-cleft side and was greater with increasing cleft sizes.
Journal of Cranio-Maxillofacial Surgery, 2003
In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analysed and the relevant role of the perinasal-perioral muscular balance, and the inborn dislocation of the alar cartilages is presented. Patients and methods: 50 CLAP patients were analysed in whom 29 primary cheiloplasties, 12 lip revisions and 9 rhinoplasties were performed. The lip repair was done by a modification of Millard's technique, the nose by either a closed or open-sky rhinoplasty. The severity of the cleft appearance was evaluated pre-and postoperatively, according to a pre-agreed visual rating scale. There were 4 degrees of severity of the deformity preoperatively (mild, moderate, severe and very severe), and postoperatively 5 categories of outcome (excellent, very good, good, satisfactory and poor) depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. Results: 17 excellent, 4 very good, 2 good, 5 satisfactory and 1 poor result were obtained in the group of primary cheiloplasty. Eight excellent, 4 very good results were obtained by the lip revisions. Seven excellent and 2 satisfactory results were obtained following rhinoplasty. Conclusions: During the primary lip repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. When correct insertion of m. transversus nasi to the nasal spine is achieved and a good repair of m. orbicularis oris, symmetry of the alae and normal growth of lip and columella was obtained even in most severe bilateral cases. In cases of diastasis of the orbicularis and transversus nasi muscles, in combination with other soft tissue deformities or scars, a secondary musculo-periosteal revision is recommended. The defect of the soft tissue triangle of the nose is best corrected via an open rhinoplasty. r 2003 European Association for Cranio-Maxillofacial Surgery.
The Angle Orthodontist
Objectives To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). Materials and Methods A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. Results No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < ....
Volumetric nasal cavity analysis in children with unilateral and bilateral cleft lip and palate
Laryngoscope, 2015
Objective-Children with cleft lip and palate (CLP) often suffer from nasal obstruction which may be related to effects on nasal volume. The objective of this study is to compare side:side volume ratios and nasal volume in patients with unilateral (UCLP) and bilateral (BCLP) clefts with age-matched controls. Study Design-Retrospective case-control study using three-dimensional nasal airway reconstructions Methods-We analyzed 20 subjects (age range: 7-12 years) with UCLP and BCLP from a regional craniofacial center who underwent cone beam CT (CBCT) prior to alveolar grafting. Ten multi-slice CT images from age-matched controls were also analyzed. Mimics ™ software (Materialise, Inc.) was used to create 3-dimensional reconstructions of the main nasal cavity and compute total and side-specific nasal volumes. Subjects imaged during active nasal cycling phases were excluded. Results-There was no statistically significant difference in affected:unaffected side volume ratios in UCLP (p=0.48) or left:right ratios in BCLP (p=0.25) when compared to left:right ratios in
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2016
Objective-Children with cleft lip and palate (CLP) often suffer from nasal obstruction which may be related to effects on nasal volume. The objective of this study is to compare side:side volume ratios and nasal volume in patients with unilateral (UCLP) and bilateral (BCLP) clefts with age-matched controls. Study Design-Retrospective case-control study using three-dimensional nasal airway reconstructions Methods-We analyzed 20 subjects (age range: 7-12 years) with UCLP and BCLP from a regional craniofacial center who underwent cone beam CT (CBCT) prior to alveolar grafting. Ten multi-slice CT images from age-matched controls were also analyzed. Mimics ™ software (Materialise, Inc.) was used to create 3-dimensional reconstructions of the main nasal cavity and compute total and side-specific nasal volumes. Subjects imaged during active nasal cycling phases were excluded. Results-There was no statistically significant difference in affected:unaffected side volume ratios in UCLP (p=0.48) or left:right ratios in BCLP (p=0.25) when compared to left:right ratios in
Three-dimensional evaluation of nasopharyngeal airways of unilateral cleft lip and palate patients
The Laryngoscope, 2014
The aim of this study was to compare the volume of nasopharyngeal airways of patients with unilateral cleft lip and palate (UCLP) with a control (noncleft) group of subjects. Retrospective case-control study. The sample consisted of 45 subjects, 30 with UCLP who underwent cone beam computed tomography (CBCT) exams as part of their workups for alveolar bone graft and 15 noncleft subjects seeking orthodontic care who obtained CBCT for diagnostic purposes. The three-dimensional volumes of nasal (NV) and oropharyngeal (PV) airways of these subjects were assessed separately using Mimics software by one well-calibrated evaluator. The images were rendered, and the volumes were measured in cm(3) . The mean PV of the UCLP subjects was 6.7 cm(3) and the mean NV was 10.3 cm(3) . The control group presented with a mean PV of 8.1 cm(3) and a mean NV of 11.6 cm(3) . Student t test showed no statistically significant difference for PV (P = 0.10) or NV (P = 0.23) when comparing cleft and noncleft subjects. Evaluation of the nasopharyngeal airways revealed that the NV and PV airways showed no difference between the cleft and noncleft subjects. It is interesting to postulate that the reported nasal abnormalities of the cleft patients do not produce a significant measurable effect on the overall volume, at least as shown in our study sample. In addition, the nasopharyngeal airways of patients are not larger than those of age-matched controls, at least at the ages that were sampled, after cleft palate repair. 3b. Laryngoscope, 2014.
Preoperative assessment of airway patency in the planning of corrective cleft nose surgery
Mund-, Kiefer- und Gesichtschirurgie : MKG, 1998
To investigate acoustic assessment of complex structural anomalies in cleft lip and palate associated nasal deformities and its impact on the planning of corrective rhinosurgery. Twenty-three consecutive patients with unilateral CL(P) during routine consultations, three of them prior to corrective surgery. Acoustic measurements of the nasal airway crosssectional area were obtained for both nasal cavities. The size of isthmus area and isthmus location as well as the nasal volume and decongestion capacity in various regions of interest were determined. Obstructions in the area of the nasal valve (< 0.4 cm2) were detected in 85% of the patients on the cleft side, but only 15% on the contralateral side. Severe mucosal hypertrophy was a common finding on the cleft side with a significantly higher capacity of decongestion, especially in the posterior region of the nasal cavity (P < 0.02). A second stenosis located behind the physiological isthmus was found in 16 patients. Acoustic r...