Skip to main content

Advertisement

SpringerLink
Log in

Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation

  • ORIGINAL ARTICLE
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Introduction

Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success.

Aim

To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip.

Methods

100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard’s rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12 months post-operatively on a 1:1 standard photograph.

Results

Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V.

Conclusion

In our study, group V, i.e., modified Millard’s repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sundine M, Phillips J (2004) Treatment of the unilateral cleft lip nasal deformity. J Craniofac Surg 15(1):69–76

    Article  PubMed  Google Scholar 

  2. Salyer KE, Genecov ER, Genecov DG (2004) Unilateral cleft lip-nose repair—long-term outcome. Clin Plast Surg 31(2):191–208

    Article  PubMed  Google Scholar 

  3. Arajy ZY, Nawres AM (2009) Primary repair of unilateral cleft lip nasal deformity. Iraqi Postgrad Med J 8(3)

  4. Li AQ et al (2002) Anatomy of the nasal cartilages of the unilateral complete cleft lip nose. Plast Reconstr Surg 109(6):1835–1838

    Article  PubMed  Google Scholar 

  5. Demke JC, Tatum SA (2011) Analysis and evolution of rotation principles in unilateral cleft lip repair. J Plast Reconstr Aesthet Surg 64(3):313–318

    Article  PubMed  Google Scholar 

  6. Somensi RS, Giancolli AP, Lucenade F (2012) Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique. Rev Bras Cir Plást 27(1):14–21

    Article  Google Scholar 

  7. Adenwalla HS, Narayanan PV (2009) Primary unilateral cleft lip repair. Indian J Plast Surg 42(Suppl):S62–S70

    Article  PubMed  PubMed Central  Google Scholar 

  8. Markus AF, Delaire J (1993) Functional primary closure of cleft lip. Br J Oral Maxillofac Surg 31(5):281–291

    Article  CAS  PubMed  Google Scholar 

  9. Gawrych E, Janiszewska-Olszowska J (2011) Primary correction of nasal septal deformity in unilateral clefts during lip repair—a long-term study. Cleft Palate Craniofac J 48(3):293–300

    Article  PubMed  Google Scholar 

  10. Armstrong GT et al (1997) A modification of the primary nasal correction in the rotation-advancement unilateral cleft lip repair. Ann Plast Surg 38(3):236–245

    Article  CAS  PubMed  Google Scholar 

  11. Chow V, Chen P, Noordhoff S (1999) The use of nasal splints in primary management of unilateral cleft nasal deformity. Plast Reconstr Surg 103(5):1347–1354

    Article  Google Scholar 

  12. Thomas C, Mishra P (2000) Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 53(1):1–6

    Article  CAS  PubMed  Google Scholar 

  13. Grayson BH et al (1999) Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 36(6):486–498

    Article  CAS  PubMed  Google Scholar 

  14. Barillas I et al (2009) Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip–cleft palate patients. Plast Reconstr Surg 123(3):1002–1006

    Article  CAS  PubMed  Google Scholar 

  15. Matsuo K, Hirose T (1991) Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 44(1):5–11

    Article  CAS  PubMed  Google Scholar 

  16. Nakajima T, Yoshimura Y, Sakakibara A (1990) Augmentation of the nostril splint for retaining the corrected contour of the cleft lip nose. Plast Reconstr Surg 85(2):182–186

    Article  CAS  PubMed  Google Scholar 

  17. Tse R (2013) Unilateral cleft lip: principles and practice of surgical management. Semin Plast Surg 26(04):145–155

    Article  Google Scholar 

  18. Raymond B, Sudjatmiko G (1970) Self made nostril retainer. Jurnal Plastik Rekonstruksi 1(2)

  19. Dhanraj P (1994) The use of a suction tube as a nostril retainer. Plast Reconstr Surg 93(3):643–644

    Article  CAS  PubMed  Google Scholar 

  20. Ozgur F, Tuncali D, Kayýkcýoglu A (1999) Securing the nostril retainer. Plast Reconstr Surg 104:1328

    Article  Google Scholar 

  21. Li J et al (2011) A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients. J Plast Reconstr Aesthet Surg 64(11):1436–1443

    Article  PubMed  Google Scholar 

  22. Pai BCJ et al (2005) Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 42(6):658–663

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Authors would like to thank Kanachur Institute of Medical Sciences and Center for Craniofacial anomalies, Yenepoya University for the encouragement and facilities provided. Authors would also like to thank Dr Srikant N for helping with the statistics.

Funding

This research did not receive any specific Grant from funding agencies.

Author information

Authors and Affiliations

  1. A Unit of Kanachur Institute of Medical Sciences, Kanachur Institute for Craniofacial Anomalies, Mangalore, Karnataka, India

    K. Mustafa

  2. Department of Maxillofacial Surgery, Dubai Health, Dubai, UAE

    Shehzana Fatima

  3. Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India

    M. V. Ashith

  4. Department of Oral and Maxillofacial Surgery, ACPM Dental College, Dhule, Maharashtra, India

    Jay Nandkishor Goyal

  5. Department of Oral and Maxillofacial Surgery, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Nitte (Deemed to be University), Mangalore, India

    Amrutha Varshini

  6. Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India

    Aafreen Aftab

Authors
  1. K. Mustafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shehzana Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. V. Ashith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jay Nandkishor Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amrutha Varshini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aafreen Aftab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amrutha Varshini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The manuscript was cleared by Institutional review board for publication and study was performed in line with the principles of the Declaration of Helsinki.

Consent to Participate

Informed consent was obtained from the parents of all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mustafa, K., Fatima, S., Ashith, M.V. et al. Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation. J. Maxillofac. Oral Surg. 22, 930–937 (2023). https://doi.org/10.1007/s12663-023-02039-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-023-02039-7

Keywords

Search

Navigation