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Secondary Cleft Nasoplasty At Primary School Age: Quantitative Evaluation of the Efficacy of Resorbable Plates
J McDaniel, B Alleyne, AK Gosain
University Hospitals Case Western Medical Center
2012-01-12
Presenter: Jarred McDaniel, MD
Affidavit:
This work in it's entirety reflects original work performed by the presenting resident under the supervision of the primary investigator.
Director Name: Dr. Arun Gosain
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This presentation directly addresses cleft nasal deformities, discusses complications of the described technique, and presents quantitative data on a recently described but relatively obscure, albeit effective surgical procedure.
How will your presentation be used by practicing physicians in the audience?
This presentation may be used to add to or improve onthe tools available to plastic surgeons to correct secondary cleft nasal deformity.
Introduction: Secondary cleft nasal deformity in children of primary school age can result in a permanent impact on self-esteem. How best to address this deformity before remains controversial.
Methods: 53 patients between 6 and 11 years old underwent secondary cleft nasoplasty with resorbable plate placement between 2003 and 2011. All patients had standardized pre-op and post-op (3 to 6 months) photos. 30 patients had late post-op photos (range 10-78 months, average 25.3 months). Basilar photos were analyzed using Mirror software (Canfield Scientific, Inc.) for nostril width and height, nasal height and nose width and tip deviation. In unilateral clefts the non-cleft nostril was used as a control. In bilateral clefts comparisons were made between photos for each patient, standardizing measurements based on intercanthal distance. Patients without available photos were excluded.
Results: 53 patients underwent nasoplasty for a total of 63 resorbable plates. In unilateral clefts improvement in nostril width, nostril height, tip height, and tip deviation were statistically significant (p<0.05) in early postoperative photos; improvements in nostril height, tip height, and tip deviation remained significant long-term. In bilateral clefts improvement in nostril height and tip height were statistically significant in early postoperative photos, with increase in nostril height remaining significant long-term. Complications consisted of partial plate exposure in 10% of patients.
Conclusions: To our knowledge this is the first quantitative evaluation of resorbable plates for secondary cleft nasoplasty. Significant and sustained improvements in nasal appearance are possible using this technique with minimal complications and sparing of native tissues.
