Nasal Function and Aesthetics in Patients with Complete Unilateral Cleft Lip, Alveolus and Palate. Summary of the Doctoral Thesis

Abstract

Cleft lip and palate is the most frequent congenital craniofacial deformity. Nose deformation is remarkable in patients with complete unilateral cleft lip, alveolus and palate. As the central feature of the face, the nose has a profound effect on general facial aesthetics, making it clearly abnormal in appearance and function in patients with clefts. Rhinoplasty for cleft lip and palate patients is very challenging owing to its complex pathology, and also frustrating because the final postoperative outcome is limited. Also, the timing and methods of nasal correction differ among clinics. The outcome of the nose surgery is difficult to evaluate, due to the three-dimensional complexity of its shape. Discussions of aesthetic evaluation of the nose in patients with cleft lip and palate remain problematical, many different methods having been described in the literature. However, there is no single reliable method for aesthetic evaluation of the nose for patients with clefts and there is no consensus about measurements, either. To evaluate nasolabial appearance and nasal function in patients with complete unilateral cleft lip, alveolus and palate objective, convenient methods are required so that the results of treatment can be assessed qualitatively and quantitatively. Literature analysis was done concerning aesthetic evaluation of the nose in patients with cleft lip and palate and positive and negative aspects of the methods were identified. The most popular evaluation method in articles was two-dimensional (2D) photography. In the first part of the study, 27 children with complete unilateral cleft lip, alveolus and palate were included for nasal aesthetic evaluation in 2D photos with modified Anastassov and Chipkov (2003) scheme and visual analogue scale. So far, this detailed aesthetic assessment scale for measuring nose in 2D photos was not described in the literature. The objectivity of the chosen method, after statistical data processing for a particular study group, was not convincing. In the second part of our study for evaluation of nasolabial symmetry three-dimensional (3D) photos with selected anthropometric landmarks were used. Measurements of the nasolabial symmetry in 3D photos were described as objective method in the literature. In the second part of study, 35 patients with complete unilateral cleft lip, alveolus and palate were included for evaluation of nasolabial appearance and nasal function enabling comparing with a group of unaffected children. The nasolabial appearance with acceptable symmetry after cleft lip and reconstructive surgery of the nose was achieved. However, symmetry of the nasolabial appearance in patients with complete unilateral cleft lip, alveolus and palate differed from control group. In control group and in non-cleft side of nose of patients with complete unilateral cleft lip, alveolus and palate nasal flow was better than in cleft side. The 3D photos with proposed set of anthropometric landmarks for evaluation of nasolabial appearance seems to be qualitative and quantitative method, but nasal aesthetic evaluation in 2D photos with proposed methods showed subjective results. For nasolabial appearance evaluation 3D photographs and anthropometric landmarks and distances should be used. The set of anthropometric landmarks and distances used in our study, might be proposed to assess nasolabial appearance after surgery routinely. Rhinomanometry could be suggested as routine examination before and after secondary nose corrections.