A panel based assessment of early versus no nasal correction of the cleft lip nose (original) (raw)
Related papers
Development of a method for rating nasal appearance after cleft lip repair
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009
The aim of this study was to develop a new method for evaluation of nasal appearance in patients after cleft lip repair. A method is described in which the nasal region is evaluated without the influence of the labial repair. Frontal, submental and profile view photographs of 45 patients after cleft lip repair were obtained. For each patient, two sets of images, one of the entire nasolabial region and one of the nasal complex in isolation, were assessed with a five-point scale by a panel of seven judges. Repeat evaluation at 1 week allowed calculation and comparison of intra-judge and inter-judge reproducibility. The interclass correlation coefficient (ICC) values were higher in the assessment of the isolated nasal complex when compared to the nasolabial region with the exception of the cleft side lateral view. The ICC value of the assessment based on all three views was the highest. The level of intra-judges and inter-judges was good, thus the reliability and sensibility of this new method is acceptable. This method is credible because acceptable pooled levels of reliability were obtained. In the future, this rating system may be used to assess nasal appearance after different treatments for cleft lip patients.
Secondary cleft rhinoplasty rejuvenates the nose: a suggestion from a panel survey
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 2011
Cleft-lip nasal deformity (CLND) affects the overall facial appearance and attractiveness. The CLND nose shares some features in part with the aging nose. This questionnaire survey examined: 1) the panel perceptions of the role of secondary cleft rhinoplasty in nasal rejuvenation; and 2) the influence of a medical background in cleft care, age and gender of the panel members on the estimated age of the CLND nose. Using a cross-sectional study design, we enrolled a random sample of adult laypersons and health care providers. The predictor variables were secondary cleft rhinoplasty (before/after) and a medical background in cleft care (yes/no). The outcome variable was the estimated age of nose in photographs derived from 8 German nonsyndromic CLND patients. Other study variables included age, gender, and career of the assessors. Appropriate descriptive and univariate statistics were computed, and a P value of <.05 was considered to be statistically significant. The sample consiste...
Photogrammetric Outcomes of Primary Nasal Correction in Unilateral Cleft Lip Patients
Annals of Plastic Surgery, 2019
Background: Concerns of nonlasting results and potential nasal growth damage precluded cleft nasal correction at the time of initial cleft lip repair. Our goal was to evaluate the outcome of primary cleft nasal correction in our patients with unilateral cleft lip. Methods: A retrospective review of patients with complete and incomplete unilateral cleft lip who underwent primary cleft nasal correction from 2010 to 2017 by the same surgeon was performed. The cleft-to-noncleft nostril height, width, one-fourth medial part of nostril height, nasal sill height, and nostril area ratios, as well as inner nostril height-to-width ratios were determined from standard basilar view photographs taken in different time points (T1, <3 months; T2, 3-12 months; T3, 12-36 months; and T4, >36 months after surgery). A 5-point visual analog scale (1 = worst, 5 = best) was used to assess each patient's nose appearance. Results: Seventy-two patients were identified (66.7% male, 51.3% with a complete cleft lip). Average visual analog scale scores T1-T4 were 3.88 ± 0.85, 3.72 ± 0.93, 3.54 ± 0.99, and 3.40 ± 0.71, respectively. Intraclass correlation ranged from 0.61 to 0.94. A significant decrease [mean difference (SD)] was found for cleft-to-noncleft nostril width ratio [0.15 (0.18)] from T1 to T2, and an increase for one-fourth medial height ratio [−0.09 (0.07)] and for inner nostril height-to-width ratio in the noncleft side [−0.23 (0.25)] from T1 to T3. Thirteen patients required secondary surgical revision. Conclusion: Based on photogrammetry, primary cleft nasal correction in our patients with unilateral cleft lip achieved acceptable and stable outcomes during early childhood.
Journal of Cranio-Maxillofacial Surgery, 2015
Backgound: Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction. Methods: Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, 05 confidence. Results: Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p ¼ 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p ¼ 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p ¼ 0.0015), nares "offset" (p ¼ 0.002), and columella symmetry (p ¼ 0.022) with nosetreatment achieving near ideal columella symmetry score (0.92) vs. (0.81). Conclusions: NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.
Nasal symmetry: a 10-year comparison between the Pigott and McComb nasal correction
British Journal of Plastic Surgery, 1991
The objective assessment of the symmetry of the cleft lip nose has not been properly evaluated. A simple technique using enlarged photographs and area assessment is described. Two different tecmques were assessed, the Pigott War leapfrog" technique and the McComb alar lift technique. The children were assessed at 10 years of age. The results show no diierences in the linear measurements or when the symmetry is assessed in the frontal view. In the worm's eye view, the Pigott correction was shown to produce a more asymmetric nose when compared with the McComb technique. Both corrections produce significant asymmetry when compared with a control group. Journalof Plastic Surgery, 39,313. WiUiams, H. B. (1968). A method of assessing cleftlip repairs: A comparison of LeMesurier and Millard techniques. Plastic and Reco~tructive Surgery, 41, 103.
The “Anatomical Balance Correction” for Secondary Cleft Lip Nasal Deformities
Journal of Craniofacial Surgery, 2016
Secondary cleft lip nasal deformities corrective procedures are still a major concern for the maxillofacial surgeons. Objective: The aim of this study was twofold, to present a new ''anatomical balance'' correction for the correction of secondary cleft nose deformities and to evaluate it through a long-term followup study. Participants: One hundred twenty patients with cleft lip and palate and secondary nasal tip deformities were recruited for this study. The age ranged from 22 to 39 years (mean: 25.9 years old). Main Outcome Measurements: The stability of the functional aesthetic result has been evaluated by means of an aesthetic protocol completed with a set of 10 photographs. Results: The 3 years follow-up study of 120 patients supports the results of the newly introduced technique that guarantees a better shaping of the nasal tip without further need of another correction procedure. Conclusions: Results indicate that the treatment of secondary cleft nose defects with the ''anatomical balance'' method gives an improvement of the tip projection by means of various techniques, thus avoiding further surgical procedures.
Evaluation of Corrective Rhinoplasty in Cleft Lip Nasal Deformity
Background: Cleft lip nasal deformities are challenging problems in all aspects and there are debates about timing, approaches, techniques as well as types of the used grafts. Objective: Evaluation of the results of corrective rhinoplasty in post cleft lip nasal deformity at Al-Azhar University Hospitals (Al-Hussien and Said Galal Hospitals). Patients and Methods: This is a prospective clinical study which included thirty patients having post cleft lip nasal deformity whom underwent corrective rhinoplasty for cleft lip nasal deformity. These patients were managed at Al-Azhar University Hospitals (Al-Hussien and Said Galal Hospitals) during the period from May 2017 to January 2019. Results: The vast majority of the operated upon patients had an obvious degree of satisfaction after 6 months to 12 months of postoperative follow up. Conclusion: Autologous cartilaginous grafts are the most suitable type of nasal grafts, and costal cartilage graft is the most superior between them. Further studies are needed to justify if primary rhinoplasty is beneficial or it disturbs the nasal symmetry and leave scared tissues for a potential future intervention.
Cleft Lip/Nose Deformity and Rhinolith
Plastic and Reconstructive Surgery, 2004
Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.
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.