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A Three Dimensional Analysis of Nasal Aesthetics Following Le Fort I Advancement in Patients with Cleft Lip and Palate
Edward H. Davidson MA (Cantab.) MBBS, Lino F. Miele, MD, MS, Oluwaseun A. Adetayo MD, Anand Kumar, MD
Unniversity of Pittsburgh Plastic Surgery
2014-03-14
Presenter: Edward H. Davidson
Affidavit:
The work is entirely the work of the resident
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
This study evaluates changes in nasal aesthetics using 3D photography after Le Fort I advancement osteotomies in patients with non-syndromic cleft-related maxillary hypoplasia.
Methods
Cephalometric parameters were recorded pre- and postoperatively. 3D photogrammetric imaging (Vectra XT Imaging System, Canfield Scientific, Inc., Fairfield, NJ) analyzed changes in nasal interalar width (IAW), internostril width (INW), nasal tip projection (NTP), collumelar length (CL), nasal labial angle (NLA), and nasal length (NL). Statistical significance between pre- and postoperative data was determined using T-tests for each parameter.
Results
Eleven patients underwent either single piece Lefort I osteotomy and advancement, (3 bilateral, 4 unilateral cleft lip and palate), or two-piece advancement (2 bilateral, 2 unilateral). Average nasal soft tissue changes were IAW 1.9mm (0.4-4.2), INW -0.2mm (-2.8-1.6), NTP -1.0mm (-4.0-2.0), CL -0.7mm (-2.9-1.5), NLA -0.2 degrees (-13.9-15.1) and NL -0.7mm (-4.3-1.5)(p=0.001, 0.6, 0.08, 0.01, 0.9, 0.2). For single-piece osteotomy alone changes were IAW 2.1mm (0.6-4.1), INW -0.6mm (-2.8-1.7), NTP -1.9mm (-4.0--0.3), CL -1.2mm (-2.9--0.03), NLA -1.3degrees (-13.9-15.0) and NL -1.1mm (-4.3-0.7)(p=0.007,0.3, 0.009, 0.0002, 0.7, 0.2). For two-piece osteotomy alone changes were IAW 1.6mm (-0.4-3.3), INW 0.5mm (0.4-1.6), NTP 0.5mm (-1.1-2.0), CL 0.2mm (-1.4-1.5), NLA 2.8 degrees (-7.6-10.1) and NL -0.1mm (-1.4-1.5)(p=0.2, 0.4, 0.5, 0.6, 0.5, 0.9).
Conclusions
Cleft-related scarring and malposition affect changes in nasal aesthetics following maxillary advancement that are different to the non-cleft population. Patients with cleft lip and palate demonstrate a predictable increase in interalar width and decrease in columellar length as well as a trend to decrease nasal tip projection following Le Fort 1 osteotomy.
