Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis

FACE ◽  
2021 ◽  
pp. 273250162110469
Author(s):  
Fady P. Marji ◽  
Madeleine K. Bruce ◽  
Erin E. Anstadt ◽  
Irene T. Ma ◽  
Jonathan Y. Lee ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Le Fort ◽  
3 Dimensional ◽  
Tip Projection ◽  
Alar Base ◽  
Nasolabial Angle ◽  
Le Fort I ◽  
Nasal Length ◽  
Nasal Changes

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement. Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student’s t-test and multivariate analysis. Differences were considered significant for P-values ≤.05. Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004). Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.

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

2020 ◽  
Vol 58 (1) ◽  
pp. 105-113
Author(s):  
Lucas M. Harrison ◽  
Rami R. Hallac ◽  
Christopher A. Derderian
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Time Points ◽  
Alar Base ◽  
Nasolabial Angle ◽  
Base Width ◽  
Nasal Length

Objective: This cross-sectional study utilizes 3-dimensional analysis to assess nasal morphology in patients with bilateral cleft lip and palate (BCLP) compared to controls across the timeline of cleft care. Design: Retrospective comparative cross-sectional study. Setting: Tertiary pediatric academic institution. Patients and Participants: One hundred and twelve patients with BCLP and an equal number of age and sex-matched control participants. Main Outcome Measure(s): Nasolabial angle, nasal length, nasal protrusion, columella length, columella width, nasal tip width, alar width, and alar base width were collected at each time point. The measurements were collected pre-nasoalveolar molding (NAM) therapy, post-NAM therapy, post-primary cleft rhinoplasty, 1 year, 5 years, 10 years, and 15 years of age. Results: Nasolabial angle and nasal tip width were significantly different from controls from pre-NAM through 15 years of age time points. Nasal length was not significantly different at any time point. Alar width and alar base width were significantly different from pre-NAM through 10 years of age time points. Nasal protrusion, columella length, and columella width were significantly different from pre-NAM through 5 years of age time points. Conclusions: This study demonstrates that three-dimensional photogrammetry is effective in assessing the changes in nasal morphology that occur throughout the course of care in patients with BCLP from before cleft lip repair to the completion of nasal growth.

Evaluation of Lefort I Osteotomy Line and Pterygomaxillary Junction Region in Patients With Cleft Lip and Palate

2020 ◽  
pp. 105566562096957
Author(s):  
Bahadır Sancar ◽  
Şuayip Burak Duman
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Le Fort I Osteotomy ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Osteotomy Line ◽  
Le Fort I ◽  
Pterygomaxillary Junction

Objective: This study aimed to evaluate the Le Fort I osteotomy line and pterygomaxillary junction via cone-beam computed tomography in individuals with cleft lip and palate (CLP). Design: Retrospective study. Patients and Methods: The study included individuals older than 16 years with CLP, who were scheduled for repositioning of the maxilla by Le Fort I osteotomy, and those with class III malocclusion with maxillary hypoplasia, who were scheduled for Le Fort I osteotomy. The measurements made in the area of the cleft of individuals with CLP were compared with both the side with no cleft and those with class III malocclusion with maxillary hypoplasia. A total of 11 measurements were made on the axial section parallel to the Frankfurt Horizontal plane, corresponding to the lower 1/5 of the distance between the infraorbital foramen and the anterior nasal spine. Results: There were significant differences both in the comparisons made between the individuals with CLP and those without CLP in terms of the canal-anterior alveolar crest (G) and sinus-anterior alveolar crest (L) measurements ( P < .05). The mean measurement values showed that the measurement results were higher in individuals with CLP in general. Conclusion: In conclusion, we believe that there might be difficulties both in osteotomy and down fracture stages during Le Fort I osteotomies performed in individuals with CLP.

Traumatic Arteriovenous Malformation following Maxillary Le Fort I Osteotomy

2008 ◽  
Vol 45 (3) ◽  
pp. 329-331 ◽  
Author(s):  
I. M. Smith ◽  
P. J. Anderson ◽  
M. J. Wilks ◽  
D. J. David
Keyword(s):  
Arteriovenous Malformation ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Rare Complication ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Le Fort I

Objective: Complications following maxillary Le Fort I osteotomy are rare. The authors present the rare complication of an arteriovenous malformation following such a procedure in a 25-year-old woman with a cleft lip and palate that was treated successfully with radiologically guided embolization.

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