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Multimodal Characterization of the Mature Septal Deformity and Airspace Associated with Unilateral Cleft Lip and Palate

Marcus, Jeffrey R., M.D.; Brown, David A., M.D., Ph.D.; Carpenter, David, B.S.; Glener, Adam, M.D.; Allori, Alexander, M.D., M.P.H.; Frank-Ito, Dennis, Ph.D.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 865-873
doi: 10.1097/PRS.0000000000005365
Pediatric/Craniofacial: Original Articles

Background: The nasal deformity that accompanies cleft conditions is often acknowledged as the most difficult obstacle to restoring facial balance in affected children. Despite considerable progress in the treatment of cleft lip and palate, the outcomes of cleft septorhinoplasty have proven variable and difficult to predict, possibly because of incomplete understanding of the underlying anatomical deformities. The authors sought to characterize unilateral cleft septal and dorsal deformities through a detailed morphologic model based on photogrammetric, qualitative, and quantitative computerized tomographic image analysis.

Methods: Twenty-five consecutive patients with a unilateral cleft nasal deformity without prior septorhinoplasty were included.

Results: Dorsal angulation, as measured by the nasal dorsal angle, consistently deviated away from the cleft side at a mean angle of 8.9 degrees. In a majority of patients, the septal deformity was complex and consistent in the anterior and middle regions of the airspace, but variable in the posterior region. Finally, discrete sites of potential nasal obstruction were noted in the anterior, middle, and posterior regions along the acoustic axis. Considerable variation was seen in the anterior and posterior regions, with potential obstructions variably on both the cleft and noncleft sides.

Conclusion: The authors’ results underscore the importance of subject-specific analysis in cleft septorhinoplasty to address multiple potential sites of nasal obstruction.

Durham, N.C.

From the Divisions of Plastic, Maxillofacial, and Oral Surgery and Head and Neck Surgery and Communication Sciences, Duke University Medical Center; and Duke University School of Medicine.

Received for publication August 23, 2017; accepted July 13, 2018.

Disclosure:No authors have any disclosures in relation to the content of this article.

Jeffrey R. Marcus, M.D., Division of Plastic, Maxillofacial and Oral Surgery, Duke University Hospital and Children’s Health Center, DUMC 3974, Room 110 Baker House, 200 Trent Drive at Erwin Road, Durham, N.C. 27710,, Instagram: @dukeplasticsurgery

Copyright © 2018 by the American Society of Plastic Surgeons