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

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.

Morphometrical Study of the European Shorthair Cat Skull Using Computed Tomography

This study aimed to perform a morphometric analysis of the skull of the European shorthair cat by using computed tomographic images. Thirty-seven computed tomography (CT) studies of healthy cats’ heads were used for linear measurements and index calculations of the skull and cranium. The following values were determined: skull length = 8.94 ± 0.45 cm, cranial length = 8.21 ± 0.42 cm, nasal length = 0.73 ± 0.17 cm, cranial width = 4.28 ± 0.26 cm, cranial index = 52.18 ± 3.75%, internal height of cranium = 2.88 ± 0.29 cm, external height of cranium = 3.35 ± 0.12 cm, internal length of the cranium = 5.53 ± 0.28 cm, external length of the cranium = 6.32 ± 0.28 cm, internal cranium index = 45.62 ± 4.77%, external cranium index = 53.06 ± 2.07%, internal cranium and skull index = 61.93 ± 2.38%, external cranium and skull index = 70.70 ± 1.72%, width of the foramen magnum = 1.34 ± 0.07 cm, height of the foramen magnum = 1.01 ± 0.09 cm, and foramen magnum index = 75.37 ± 5.76%. It was also found that the population was homogeneous, with the exception of nasal length (NL), and that there was a sexual dimorphism present, with males exhibiting higher dimensions. This work contributed to characterizing the morphometry of the cranium and skull of the domestic cat, a knowledge of utmost importance for the diagnosis and treatment of conditions affecting this complex anatomical region.

The Layered Anatomy of the Nose: An Ultrasound-Based Investigation

Background An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. Objectives To describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. Methods A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose using ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. Results In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n= 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% - 67.5% in relation to nasal length. The nasal arteries coursed superficially in 91.7% of all cases in the nasal radix, in 80% in the mid-nasal dorsum, and in 98.3% in the nasal tip. Conclusions Soft tissue filler administration in the nose carries the highest risk for irreversible vision loss compared to any other facial region. The safety of soft tissue filler rhinoplasty procedures is enhanced by knowledge of the layered anatomy of the nose, the location and depth of the major nasal vasculature, and employment of maneuvers to decrease the risk of blindness.

Craniometric Analysis of European Rabbit (Oryctolagus Cuniculus) Breeds to Trace out Intraspecific and Inter Gender Morphometric Variations

The family Liproidae expresses the significant variation of morphometric features at species level. In already available literature on the European rabbit (Oryctolagus cuniculus) the idea is proposed that there can be variation in the morphometric character of different breeds of Oryctolagus cuniculus but there are negligible scientific research base evidences for it. So in this study interbreed craniometric comparison of the European rabbit is carried out to trace out their intergender and intraspecific morphometric variations. The study material consists of 32 sexually mature rabbits belong to two breeds of European rabbit that are New Zealand rabbit (eight males and eight females) and American Dutch rabbit (eight males and eight females) collected from different districts of the Punjab, Pakistan. There were 29 different measurements taken from the skull and mandible of both breeds by using digital and manual verniar calipers. The results of this study have revealed that there is significant interbreed variation in the nasal length measurement of the New Zealand and American Dutch rabbit. This significant interbreed difference in nasal length is observed in both female as well as male rabbits (p=0.0059 and 0.0069 respectively). The current study also depicts that inter gender craniometric variations exist in the New Zealand as well as American Dutch rabbit. The standard deviation of the foramen magnum index of the both included breeds is comparatively higher than all the other included morphometric features. This study provides the baseline data on interbreed craniometric variations in the Oryctolagus cuniculus.

Endothelin B Receptor Mutant Exhibits Craniofacial Dysmorphology Resembling Domestication Syndrome

Background: ETB-/- mutation is a major cause of HSCR, a neurocristopathy known for its enteric nervous system failure. Other than regulating ENCC migration, ETB mediates ET-1 clearance. Consequently, ETB may indirectly affect ET-1/ETA signaling, which controls CNCC migration and craniofacial development. Interestingly, it was hypothesized that “domestication syndrome” arise from changes in neural crest determining genes, including ETA and ETB. While ETA-/- animals are known to suffer severe dysmorphology resembling CATCH22 syndrome, we hypothesize that sl/sl rat, an ETB-/- HSCR model animal, may exhibit subtle craniofacial changes through indirect control. These features may share resemblance to those of domestication syndrome. Methods: Ten rat pups with an average age of 88 hours were anaesthetized with 5% isoflurane and culled via exsanguination. Tail tips were removed for genotyping. Head tissue were stained in 1.5% iodine for two weeks prior to micro-CT scanning. In vivo micro-CT scanning of cranial specimen was performed followed by ex vivo micro-CT scanning of 2 samples for image quality control. 3D visualization and analyses were performed using open-source program, Drishti. Cephalometric measurements were made based on selected craniofacial landmarks. Comparisons were made between sl/sl rats and the control group, which consisted of wild-type and heterozygotes. Results: Subtle reductions in facial measurements were seen in sl/sl rats when compared with the control group, ranging from 1.4% to 15%. These changes were observed in cranial, maxillary and mandibular parameters: total skull length, nasal length, nasal width, nasal cavity width, interorbital width, interlens distance, inner and outer canthal distance, maximal skull height, cranial length, intracranial length and width, interorbital width, and interzygomatic width. Consistently, craniofacial ratio indices showed sl/sl rat has a flatter cranium (skull height/skull length: 0.393 vs 0.413) and a shorter but broader nose (nasal-width/nasal-length: 0.794 vs 0.874). Additionally, subtle dystopia canthorum may be presented in sl/sl rat based on increased W index. While there was no discrepancy in dental number and morphology between the control and sl/sl groups, dimensional difference was detected. Conclusions: This study demonstrated subtle craniofacial changes are presented in ETB-/- HSCR model, supporting the idea that ETB regulates CNCC migration. The findings also implicate HSCR patient may have predisposing risks for conditions such as obstructive sleep apnea, cleft palate, or dental malocclusion. Lastly, these changes share resemblance with described domestication syndrome, supporting NCC-determining gene, ETB, may play a role in the formation of domestication.

The Caudal Septum Pivot Technique for Short Nose Correction

The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.