Unilateral cleft lip nasal deformity: 3D analysis of the primary deformity and longitudinal changes following primary correction of the nasal foundation.

Abstract

BACKGROUND Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical to optimizing cleft care. We used 3D images to evaluate nasal base morphology. METHODS Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (N=102). 3D images pre-op, post-op, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, cranio-caudal, and antero-posterior axes. RESULTS Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Non-cleft subalare was 2.3 mm laterally displaced. Regression analysis with deviation of subnasale from midline as dependent variable revealed progressive lateral displacement of non-cleft subalare, narrowing of non-cleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes resulting in landmark positions similar to controls. The symmetry of nasal base correction persisted at 5-year follow-up with no recurrent cleft alar base retrusion, regardless of initial cleft type. CONCLUSIONS Unilateral cleft lip nasal deformity may be 'driven' by displacement of anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded whereas the non-cleft alar base is displaced lateral. Changes with surgery involve anterior movement of cleft alar base but also include medial movement of non-cleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely upon alveolar bone grafting.