Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis. (December 2021)

• Record Type: Journal Article
• Authors: Marji, Fady P.; Bruce, Madeleine K.; Anstadt, Erin E.; Ma, Irene T.; Lee, Jonathan Y.; Chow, Ian; Beiriger, Justin; Losee, Joseph E.; Goldstein, Jesse A.
• Is Part Of: FACE. Volume 2:Number 4(2021)
• Page Start: 377
• Page End: 385
• Publication Date: 2021-12
• Subjects: nasal esthetics -- Le Fort I -- 3D imaging -- cleft lip and palate; 617.5
• DOI: 10.1177/27325016211046962
• Languages: English
• ISSNs: 2732-5016

Abstract

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement.Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student's t -test and multivariate analysis. Differences were considered significant for P -values ≤.05.Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004).Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.