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.

Sino-Nasal Changes Associated with Midfacial Expansion: An Overview

The concept of palatal expansion can be viewed as an anachronism since the delivery and scope of this clinical technique has changed dramatically over the past few decades. Indeed, since the palatal complex does not exist in isolation, clinicians ought to be cognizant of how palatal expansion affects contiguous midfacial structures. Because of this structural arrangement, surgical and non-surgical palatal expansion can have clinical consequences on the dentoalveolar structures, which are dependent on bony remodeling of the maxillo-palatine complex. In addition, it can also be suggested that morphologic alterations of the maxillary air sinus might lead to functional and clinical improvements of inflammatory changes associated with rhinosinusitis. Furthermore, enhancements in the nasal airway could affect a host of other conditions, including nasal breathing and obstructive sleep apnea, etc. Therefore, the aim of this chapter is to review the effects of midfacial expansion techniques on contiguous structures, including the paranasal sinuses.

Nasal considerations with the Le Fort I osteotomy

Orthognathic surgery involves the correction of severe dentofacial deformities through a combination of orthodontics, surgery and, occasionally, restorative dentistry. This procedure, when involving surgical movement of the maxilla, can lead to changes in the overlying nasal morphology. In this paper, the standard nasal assessment that is undertaken prior to a Le Fort I osteotomy is outlined along with the reported nasal changes seen following this procedure. In addition, the various risk factors associated with adverse nasal changes are considered, as are the management techniques adopted by clinicians to minimize these changes CPD/Clinical Relevance: Clinicians should be aware of the adverse nasal changes associated with the Le Fort I osteotomy.

REALISASI BAHASA INDONESIA PENDERITA BIBIR SUMBING SEBUAH STUDI KASUS

AbstrakPenelitian ini bertujuan untuk mengidentifikasi realisasi dan perubahan fonem bahasa Indonesia berupa kata, frasa, dan kalimat yang diucapkan penderita bibir sumbing. Penelitian ini menggunakan pendekatan penelitian studi kasus. Objek dalam penelitian ini berupa (1) realisasi kata, frasa, dan kalimat bahasa Indonesia, perubahan fonem yang mengiringinya, dan fonem-fonem yang sulit diujarkan oleh penderita bibir sumbing. Sumber data (informan) dalam penelitian ini adalah dua orang penderita bibir sumbing (labiozchis) yang berusia 40 tahun dan 13 tahun. Penyediaan data menggunakan metode simak dan teknik (1) simak libat cakap, (2) rekam, (3) catat. Analisis data menggunakan metode padan dan teknik hubung banding menyamakan. Hasil penelitian menunjukan konsonan letupan, geseran, sampingan, geletar, dan sengauan mengalami perubahan fonem yang tidak konsisten. Artinya perubahan bergantung pada fonem yang menyertai.Kata kunci: fonetik, realisasi bahasa Indonesia, bibir sumbing, anak berkebutuhan khusus, studi kasus CLEFT LIP SUFFERERS AND ITS REALIZATION IN INDONESIAN LANGUAGE AbstractThe research aimed to identify the realization and phoneme changes in Indonesian language in the form of words, phrases and sentences uttered by cleft lip sufferers. The study used a case study as its research design. The objects in research are (1) the realization of words, phrases, and sentences, (2) the phoneme changes, and (3) difficult phonemes in Indonesian language uttered by cleft lip sufferers. The participants of the study are two cleft lip sufferer (labiozchis) with two different age level of 40 and 13 years old. For collecting the data, this study implemented some techniques: (1) observation (2) recording, and (3) notetaking. For analysing the data, this study used the connecting and comparing techniques. The result showed the fricative phonemes, as well as the lateral, trill, and nasal changes tended to be inconsisten. The changes depend on the preceding phonemes.Key word: phonetic, Indonesian language realization, cleft lip, childern with special need, case study

Three-Dimensional Soft Tissue Nasal Changes After Nasoalveolar Molding and Primary Cheilorhinoplasty in Infants With Unilateral Cleft Lip and Palate

Objective: To quantify 3-dimensional (3D) nasal changes in infants with unilateral cleft lip with or without cleft palate (UCL±P) treated by nasoalveolar molding (NAM) and cheilorhinoplasty and compare to noncleft controls. Design: Retrospective case series of infants treated with NAM and primary cheilorhinoplasty between September, 2012 and July, 2016. Infants were included if they had digital stereophotogrammetric records at initial presentation (T1), completion of NAM (T2), and following primary cheilorhinoplasty (T3). Images were oriented in 3dMD Vultus software, and 16 nasolabial points identified. Patients: Twenty consecutively treated infants with UCL±P. Interventions: Nasoalveolar molding and primary cheilorhinoplasty. Main Outcome Measures: Anthropometric measures of nasal symmetry and morphology were compared in the treatment group between time points using paired Student t tests. Postsurgical nasal morphology was compared to noncleft controls. Results: Nasal tip protrusion increased, and at T3 was 2.64 mm greater than noncleft controls. Nasal base width decreased on the cleft side by 4.01 mm after NAM and by 6.73 mm after cheilorhinoplasty. Columellar length of the noncleft to cleft side decreased from 2:1 to 1:1 following NAM. Significant improvements in subnasale, columella, and nasal tip deviations from midsagittal plane were observed. Treatment improved symmetry of the alar morphology angle and the nasal base–columella angle between cleft and noncleft sides. Conclusions: Three-dimensional analysis of UCL±P patients demonstrated significant improvements in nasal projection, columella length, nasal symmetry, and nasal width. Compared to noncleft controls, nasal form was generally corrected, with overcorrection of nasal tip projection, columella angle, and outer nasal widths.

Nasal changes associated with exercise in athletes: systematic review

Background:The prevalence of rhinitis in athletes has frequently been studied in combination with asthma, but the impact of exercise on the paracrine and secretory functions of nasal mucosa is less well established. This systematic review aimed to examine the effect of exercise on nasal mucosa in elite athletes.Method:A systematic search of Medline, Embase and the non-Medline subset of PubMed, from inception to 8th March 2016, was performed to identify studies on rhinitis in athletes.Results:Of the 373 identified unique articles, a total of 8 studies satisfied the criteria for this review.Conclusion:There is no evidence in the existing literature that indicates a reduction in nasal airway induced by exercise. Olfaction and mucociliary transport time are affected in swimmers, which can likely be attributed to chlorine irritation and which resolves with training cessation. Short-term strenuous exercise may trigger changes in cytology and prolonged mucociliary transport time, which also resolve quickly with rest.