Multi-modal Characterization of the Mature Septal Deformity and Airspace Associated with Unilateral Cleft Lip and Palate

Background: The nasal deformity that accompanies cleft conditions is often acknowledged as the most difficult obstacle to restoring facial balance in affected children. Despite considerable progress in the treatment of cleft lip and palate, the outcomes of cleft septorhinoplasty have proven variable and difficult to predict, possibly due to incomplete understanding of the underlying anatomic deformities. We sought to characterize the unilateral cleft septal and dorsal deformities through a detailed morphologic model based on photogrammetric, qualitative, and quantitative computerized tomography (CT) image analysis. Methods: Twenty- five consecutive patients with a unilateral cleft nasal deformity without prior septorhinoplasty were included. Results: Dorsal angulation, as measured by the nasal dorsal angle (NDA), consistently deviated away from the cleft side at a mean angle of 8.9 degrees. In a majority of patients, the septal deformity was complex and consistent in the anterior and middle regions of the airspace, but variable in the posterior region. Finally, discreet sites of potential nasal obstruction were noted in the anterior, middle, and posterior regions along the acoustic axis. Considerable variation was seen in the anterior and posterior regions with potential obstructions variably on both the cleft and non-cleft sides. Conclusions: Our results underscore the importance of subject-specific analysis in cleft septorhinoplasty in order to address multiple potential sites of nasal obstruction. Financial disclosure statement: No authors have any disclosures. Corresponding author: Jeffrey R. Marcus, MD, Director, Duke Cleft & Craniofacial Center, Children's Chief of Surgery, Duke Children's Hospital, Duke Cleft & Craniofacial Center Chief, Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital & Children's Health Center, DUMC 3974 — Room 110 Baker House, 200 Trent Drive at Erwin Road, Durham, NC 27710 , jeffrey.marcus@duke.edu 919-668-3110 ©2018American Society of Plastic Surgeons

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