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Unilateral Cleft Lip Deformity and Nasal Airway Obstruction: Contributions by the Bony Septum
Michael T. Friel M.D., John M Starbuck Ph.D., Ahmed M. Ghoneima D.D.S., Ph.D.2, Kariuki Murage M.D. , KatherineS Kula M.S., D.M.D., Sunil Tholpady M.D., Ph.D., Robert J. Havlik M.D., Roberto L. Flores
Indiana University
2013-01-21
Presenter: Michael Friel
Affidavit:
Michael Friel (and Roberto Flores): 65%
John Starbuck, Ahmed Ghoneima:25%
Kariuki Murage, Sunil Tholpady: 5%
Katherine Kula and Robert Havlik: 5%
Director Name: Robert Havlik, M.D.
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Patients with unilateral cleft lip deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We have observed that the bony septum can significantly contribute to nasal airway obstruction, yet bony septoplasty is uncommonly performed in cleft patients. We report on the dimensions of the nasal airway, and the contributions of the bony septum to airway obstruction in cleft patients through Cone Beam Computed Tomography (CBCT) imaging.
Methods:
A two year (2009 – 2011) review of all patients with unilateral cleft lip and palate who underwent CBCT imaging (n=22) was conducted. The CBCT of the nasal airway was subsequently divided into equal thirds in the sagittal plane for an anterior, middle, and posterior nasal airway. Dolphin software was used to generate 3-D volumetric analysis of the nasal airway. The nasal airway was divided into multiple standardized sections for analysis of the nasal septum.
Results:
The average age at time of CBCT was 10.8 yrs. The unaffected nostril was, on average, 38.7% larger than the affected nostril (p<0.01). The posterior/bony nasal airway segment was an average of 43.1% larger by volume on the unaffected side. The average deviation of the septum at the posterior nasal spine was 5.4mm to the affected side as measured by CBCT, which accounted for 74.4% of maximal deviation.
Conclusions:
The bony nasal septum contributes to volumetric irregularities in the posterior nasal airway and surgeons should consider a bony septoplasty in their treatment algorithm in patients with a cleft who have reached skeletal maturity.
