Changes to the Cleft Nose Aesthetic after LeFort I Advancement: a 3D Analysis
Irene T. Ma, MD1, Jonathan Y. Lee, MD2, Loni M. Brueckmann, BS3, Ian Chow, MD1, Joseph E. Losee, MD2, Jesse A. Goldstein, MD2.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA, 3University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Background: In the cleft patient, scarring from prior corrective surgeries along with the anatomic aberrancy in the cleft nose leads to poor predictability of nasal changes after midface advancement. Nasal changes in the non-cleft patient after LeFort I advancement is well documented. Those changes are characterized by an increase in alar base width, tip projection, and nasolabial angle. Conversely, the study of nasal changes in cleft orthognathics is limited.
Methods: A retrospective chart review was performed of all patients at a single institution who had a cleft lip/palate undergoing LeFort 1 advancement with pre and postoperative 3-dimensional (3D) photos. With 3D imaging software, pre and postoperative measurements were obtained, facilitating both 2D and 3D analysis of nasal changes. Statistical analysis was performed to determine changes in nasal parameters.
Results: Nineteen patients (10 girls, 9 boys) met inclusion criteria. All nasal parameters other than nasolabial angle and nasal length changed significantly following surgery. Alar base and flare width both increased significantly (1.3mm, p<0.001; 2.3mm, p=0.003), while both total tip projection and relative tip projection decreased (2.0mm, p=0.001, 3.4mm, p<0.001). In addition, 3D analysis of the nose demonstrated an advancement of the entire nasal complex surface postoperatively (1.0mm, p<0.0005). Unilateral cleft lip patients had a significantly wider alar base following surgery than bilateral cleft palate patients (-4.06±3.41, -0.98±2.15, p=0.032). On multiple linear regression, the presence of a cinch stitch decreases the nasolabial angle (p=0.024), but increases nasal length (p=0.004). Bilateral cleft morphology decreases total tip projection (p=0.024), but increases 3D nasal change (p=0.028).
Conclusions: There are discrepancies in the nasal changes that occur after Lefort I advancement between the cleft and non-cleft population, primarily regarding projection and rotation of the tip. Although the entire nasal surface is advanced postoperatively, tip projection is reduced and rotation limited, potentially indicating scar burden as a significant contributor to changes in nasal aesthetics after cleft orthognathic surgery.
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