Measurement and Evaluation of the Alar Base in Unilateral Secondary Lip Nasal Deformities by Three-Dimensional Computed Tomography

Abstract

Objective

This study aimed to analyze the asymmetry of the pyriform aperture and alar base in patients with unilateral secondary nasal deformities by three-dimensional computed tomography (3D-CT).

Methods

3D-CT images of the subject group of 101 adult patients and of a control group of 65 normal adults were examined. Sixty-nine patients without alveolar bone grafting (ABG) were classified as Group A, and 32 patients with ABG were classified as Group B. Seven landmarks (INM, LPA, IPA, Gbase, Gsup, Glat, and Sbal) were measured for both the subject and control groups, and comparative analyses were done to assess the degree of asymmetry in the subject group.

Results

For over 95% of Group A and 80% to 85% of Group B, the index of LPA and IPA showed asymmetry or marked asymmetry. The index of Gbase, Glat, Gsup, and Sbal showed symmetry for around 50% of Group A and about 60% of Group B. In Group A, dorsal, lateral, and caudal translocation was found on the cleft side in LPA and IPA, while all soft landmarks showed dorsal translocation. In Group B, caudal translocation was found in both LPA and IPA, but only LPA appeared dorsal on the cleft side, while Glat showed dorsal and caudal translocation.

Conclusion

The results indicated that the degree of asymmetry of hard tissue landmarks far exceeded that of the soft tissue landmarks, and the degree of asymmetry of pyriform aperture was higher than expected for patients after ABG.

Keywords

3D-CT nasal deformity unilateral cleft lip

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References

Bardach

Cutting

Anatomy of the unilateral and bilateral cleft lip and nose. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 150–159.

Cohen

Smith

B.E.

Daw

J.L.

Secondary unilateral cleft lip nasal deformity: functional and esthetic reconstruction. J Craniofac Surg. 2003; 14: 584–593.

Dai

Zhu

Zhou

G.X.

Wang

Y.P.

Liao

The monitoring of cleft lip with or without cleft palate in China: 1996–2000. Chin J Stomatol. 2003; 38: 438–440.

Devlin

M.F.

Ray

Raine

Bowman

Ayoub

A.F.

Facial symmetry in unilateral cleft lip and palate following alar base augmentation with bone graft: a three-dimensional assessment. Cleft Palate Craniofac J. 2007; 44: 391–395.

Farkas

L.G.

Anthropometry of the Head and Face. 2nd ed. New York: Raven Press; 1994: 21–24.

Feichtinger

Mossböck

Kärcher

Evaluation of bone volume following bone grafting in patients with unilateral clefts of lip, alveolus and palate using a CT-guided three-dimensional navigation system. J Craniomaxillofac Surg. 2006; 34: 144–149.

Feichtinger

Mossböck

Kärcher

Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study. Cleft Palate Craniofac J. 2007; 44: 142–148.

Kau

C.H.

Medina

English

J.D.

Xia

Gateno

Teichgraber

A comparison between landmark and surface shape measurements in a sample of cleft lip and palate patients after secondary alveolar bone grafting. Orthodontics (Chic). 2011; 12: 188–195.

Kwon

T.G.

Park

H.S.

Ryoo

H.M.

Lee SH. A comparison of craniofacial morphology in patients with and without facial asymmetry—a three-dimensional analysis with computed tomography. Int J Oral Maxillofac Surg. 2006; 35: 43–48.

10.

Lou

Lagravere

M.O.

Compton

Major

P.W.

Flores-Mir

Accuracy of measurements and reliability of landmark identification with computed tomography (CT) techniques in the maxillofacial area: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 402–411.

11.

Maeda

Katsumata

Ariji

Muramatsu

Yoshida

Goto

Kurita

Ariji

3D-CT evaluation of facial asymmetry in patients with maxillofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 382–390.

12.

Miyamoto

Nagasao

Nakajima

Evaluation of cleft lip bony depression of piriform margin and nasal deformity with cone beam computed tomography: “retruded-like” appearance and anteroposterior position of the alar base. Plast Reconstr Surg. 2007; 120: 1612–1620.

13.

Nagasao

Ogata

Miyamoto

Jiang

Kaneko

Isshiki

Nakajima

Alveolar bone grafting for patients with unilateral complete alveolar and palatal clefts improves the bony structure of the nose. Cleft Palate Craniofac J. 2009; 46: 9–18.

14.

Sander

Daskalogiannakis

Tompson

Forrest

Effect of alveolar bone grafting on nasal morphology, symmetry, and nostril shape of patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2011; 48: 20–27.

15.

Sundine

M.J.

Phillips

J.H.

Treatment of the unilateral cleft lip nasal deformity. J Craniofac Surg. 2004; 15: 69–77.

16.

Tai

C.C.

Sutherland

I.S.

McFadden

Prospective analysis of secondary alveolar bone grafting using computed tomography. J Oral Maxillofac Surg. 2000; 58: 1241–1249.

17.

Terajima

Yanagita

Ozeki

Hoshino

Mori

Goto

T.K.

Tokumori

Aoki

Nakasima

Three-dimensional analysis system for orthognathic surgery patients with jaw deformities. Am J Orthod Dentofacial Orthop. 2008; 134: 100–111.

18.

Wang

G.M.

Qian

Y.F.

Y.S.

Chen

Z.Q.

Evaluation of bone volume of alveolar cleft before and after bone graft. West China J Stomatol. 2008, 26(3): 284–286.

19.

Yanez-vico

R.M.

Iglesias-Linares

Torres-Lagares

Gutiérrez-Pérez

J.L.

Solano-Reina

Three-dimensional evaluation of craniofacial asymmetry: an analysis using computed tomography. Clin Oral Investig. 2010; DOI 10.1007/s00784-010-0441-7.

20.

Q.Z.

H.S.

Z.Y.

Zhang

R.H.

Yang

X.X.

Gao

X.Y.

Study on the location standard of skeletal landmarks on three-dimensional reconstructive images in facial asymmetry. J Tiss Engin and Reconstr Surg. 2006; 2: 140–144.

21.

Zemann

Santler

Kärcher

Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3D-COMOS measuring system. J Craniomaxillofac Surg. 2002; 30: 148–153.