Background: Patients with bilateral cleft lip–cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls.
Methods: A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip–cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas.
Results: All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points.
Conclusions: This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip–cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip–cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age.
Portland, Ore.; Madison, Wis.; and New York, N.Y.
From the Division of Plastic and Reconstructive Surgery and the Department of Orthodontics, Oregon Health and Science University; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health; and the Institute of Reconstructive Plastic Surgery, New York University Medical Center.
Received for publication June 24, 2010; accepted October 18, 2010.
The first two authors should be considered co–first authors.
Presented at the 64th Annual Meeting of the American Cleft Palate–Craniofacial Association, in Broomfield, Colorado, April 23 through 28, 2007.
Disclosure: The authors certify that, to the best of their knowledge, no financial support or benefits have been received by any coauthor, by any member of their immediate families, or by an individual or entity with whom or with which they have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported on in this article.
Barry H. Grayson, D.D.S.; Institute of Reconstructive Plastic Surgery; New York University Medical Center; 560 First Avenue; New York, N.Y. 10016; firstname.lastname@example.org