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Objective Tools to Analyze the Lower Lateral Cartilage in Unilateral Cleft Lip Nasal Deformities

Saleh, Mohamed A. MD, MRCS(Eng)*; Elshahat, Ahmed MD*; Emara, Maher MD, PhD; Hussein, Heba MD*; Gould, Lisa MD, PhD; Smith, David Jr MD; Awad, Mostafa A. MD*

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1435-1439
doi: 10.1097/SCS.0b013e31821d17d3
Technical Strategies

Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.

From the *Plastic Surgery Department and †Histology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; and ‡Plastic Surgery Division, Faculty of Medicine, University of South Florida, Tampa, Florida.

Received July 20, 2010.

Accepted for publication August 1, 2010.

Address correspondence and reprint requests to Ahmed Elshahat, MD, Plastic Surgery Department, Ain Shams University, 38 Elshaheed Said Afify Ali St, Ard Elgolf, Nasr City, 11371 Cairo, Egypt; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD