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ABSTRACT: The aim of this study was to analyze the accurate three-dimensional positions and positional changes of the lip and nose in patients with unilateral cleft lip and palate.
Sixty-three patients with unilateral complete cleft lip and palate (UCLP) and 96 patients with isolated cleft palate were retrospectively enrolled. Facial casts of all subjects taken immediately before and after cheiloplasty and before palatoplasty were used. Three-dimensional values of 12 landmarks were measured by electronic caliper and parallel milling machine. Independent-samples t test was used in analyzing positional differences between UCLP and control, and 2-way analysis of variance was selected in analyzing positional changes among UCLP groups. The threshold of significance was set at 0.05.
Superiorly dislocated christa philtri (Cph) (P < 0.001), subalae (Sa) (P < 0.001), and nostril tip (Nt) (P < 0.001) were partially corrected and still dislocated (P < 0.05, P < 0.001, P < 0.001) immediately after operation, but Cph (P = 0.322) and Cph' (P = 0.081) developed caudally to normal about 10 months after primary surgery. In sagittal dimension, lip and nose, especially Cph' (P < 0.001), Sa' (P < 0.001), and Nt' (P < 0.001) on the cleft side, dislocated dorsally before operation. Immediately after operation, Sa' (P = 0.456) and Nt' (P = 0.067) were normal in sagittal projection, but Cph' was corrected partially and still insufficient (P < 0.001). Unfortunately, sagittal projections of all nasolabial structures, Cph (P < 0.001), Sa' (P < 0.001), Nt (P < 0.001), Cph' (P < 0.001), Sa' (P < 0.05), and Nt' (P < 0.001), decreased significantly and were insufficient after operation.
In vertical dimension, nasolabial displacements were corrected partially by primary surgery, and catching-up growth happened since then. Insufficient sagittal projections of the lip and nose were corrected successfully by lip repair, but lip repair itself had adverse effects on nasolabial sagittal growth.
The Journal of craniofacial surgery 03/2013; 24(2):473-8. · 0.81 Impact Factor
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ABSTRACT: OBJECTIVE: The aim of this study was to test the accuracy of a plaster cast fabricated with a facial custom tray. STUDY DESIGN: Sixteen patients with unilateral cleft lip and palate were enrolled in this study. Cone beam computed tomography (CBCT) scanning and facial plaster cast were obtained before surgery. Three-dimensional (3D) coordinates of 6 selected landmarks were recorded directly in CBCT by Mimics and indirectly on the plaster cast by using an electronic caliper and parallel milling machine. The accuracy of the plaster cast was compared with that of CBCT by using the t test and Lin's concordance correlation coefficient. P values less than 0.05 were considered statistically significant. RESULTS: Horizontal and vertical measurements were larger and sagittal measurements were smaller in plaster cast measurements, but none of these differences was statistically significant (P values ranged from 0.063 to 0.774). Lin's agreement test also showed that the plaster cast had high agreement with CBCT measurements (concordance correlation coefficients ranged from 0.6319 to 0.9599). CONCLUSIONS: Plaster cast fabricated with a custom tray is an accurate method in facial 3D analysis.
Oral surgery, oral medicine, oral pathology and oral radiology. 08/2012;
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ABSTRACT: OBJECTIVE: To evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times. DESIGN: This study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student's t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level. RESULTS: The data showed that UCCLPs who had palatoplasty between 7 and 12years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4years of age, and UCCLPs who had palatoplasty at 4-12years had smaller Y-axis angle than those operated on before 4years of age. CONCLUSIONS: The maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4-12years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4years. UCCLPs operated using the von Langenbeck technique at 4-12years had better head-face morphology than those operated on before 4years. There was no difference in facial morphology among UCCLPs with palate repair at 4-12years.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 04/2012; · 1.25 Impact Factor
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ABSTRACT: The aim of this study was to explore the bone-soft tissue relationships around the nasolabial area in uncorrected secondary unilateral cleft nose deformities.
Measurements taken from photographs and cone-beam computerized tomography (CBCT) results were derived and paired up to represent the deformity features of bone and soft tissue, respectively.
All soft tissue measurements were significantly smaller than the corresponding bone measurements. Various bone-soft tissue correlation patterns were observed in different measurement pairs.
The adopted photography-CBCT combined measurement method appeared to be reliable in evaluating the hard-soft tissue relationships in the nasolabial area. In unoperated unilateral cleft nose deformities, bony deformities would decide the soft tissue contours, and soft tissue in turn could camouflage the underlying bone deformities in various patterns and scale, making the external configuration less deformed than its bone basis.
Oral surgery, oral medicine, oral pathology and oral radiology. 03/2012; 113(3):300-7.
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ABSTRACT: OBJECTIVE: The aim of this study was to assess the nasolabial symmetry of unilateral complete cleft lip patients repaired by West China modified Millard technique. STUDY DESIGN: Photographs of 31 unilateral complete cleft lip patients were taken before, immediately after, and 1 year after the surgery. Photogrammetric measurements were taken to evaluate nasolabial symmetry. RESULTS: Symmetry for the christa philtri point was attained immediately after the surgery and maintained in the 1-year follow-up. The cheilion point and the sub alare point, however, did not achieve symmetry until 1 year after surgery. The alar point, unfortunately, never achieved satisfactory symmetry in this study. The ratio of symmetry for none of the above-mentioned facial landmarks had linear correlations with the width of the fissure or other facial anthropometric measurements. CONCLUSIONS: Symmetry could be achieved in most of the nasolabial anthropometric landmarks after our modified Millard procedure.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 02/2012; · 1.50 Impact Factor
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ABSTRACT: Alveolar bone graft is considered conducive to tooth eruption and maxilla stability in unilateral cleft patients, but its contribution to nasal symmetry is still under discussion. To explore the detailed effects of alveolar bone graft on nasal symmetry and its role in rhinoplasty, 90 mixed-dentition complete unilateral cleft lip and palate patients were studied and categorised according to the operation they underwent during the mixed dentition period (bone graft, secondary rhinoplasty or bone graft and rhinoplasty combined). Standardised frontal and submental oblique photographs were taken before and after surgery, and objective measurements for the evaluation of nasal symmetry were devised. Measurement reliability was examined with the intraclass correlation coefficient. Intra- and inter-group comparisons were performed to explore the effect of bone graft on nasal symmetry and its role in rhinoplasty. The intraclass correlation coefficient values were >0.84. Preoperative inter-group analysis yielded satisfactory comparability. Among the bone-graft-only patients, seven of 10 measurements demonstrated significant differences, five indicated enhanced symmetry and two indicated compromised symmetry. For the rhinoplasty-only patients, all measurements revealed significant improvement. Compared with the patients who underwent rhinoplasty only, those who underwent combined bone graft and rhinoplasty were superior in nasal-base elevation only. The photogrammetric strategy appeared reliable for evaluation of nasal symmetry. Most of the effects imposed by alveolar bone graft on nasal symmetry were localised to the alar base and would be camouflaged by rhinoplasty. Considering the limited benefit in symmetry and the potential risk of more complications, overextended dissection during mixed dentition bone graft may be unnecessary.
Journal of Plastic Reconstructive & Aesthetic Surgery 07/2011; 64(11):1436-43. · 1.49 Impact Factor
