Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications

The Yin and Yang of Primary Unilateral Cleft Lip and Nose Repair: Balance through Opposing Cleft and Noncleft Side Changes

“…Images were normalized to x , y , and z axes, as described previously, 19 with the facial midline midway between endocanthion points. Landmarks were placed on preoperative and postoperative images of each subject using 3D Slicer (version 4.11.20210226).…”

“…2,3 Although classic descriptions of uCLND emphasize lateral deviation of the cleft side alar base [4][5][6][7][8][9][10][11][12][13][14][15][16] and consider the noncleft side to be the "ideal normal," 17,18 objective analysis has revealed otherwise. 19 Uncoupled growth of the premaxilla 20 results in an outward swing of the anterior nasal spine 19,21 with consequent deviation of columella and noncleft alar base away from midline. 19,21,22 Meanwhile, deficiency of the lesser segment 21 results in retrusion of the cleft alar base, 19,21,22 such that the orthogonal displacements result in a twisting collapse of the nose.…”

“…22 We also found that opposing cleft and noncleft side deformities occur, and worsen, through the spectrum of presentation: as the cleft medial lip height diminishes, the noncleft medial lip height elongates; as the cleft nasal sill widens, the noncleft nasal sill narrows; and as the cleft alar dome collapses, the noncleft alar dome rises to become more "boxy." 19,23 Although noncleft side deformities may be apparent to some surgeons, they have not been well described or documented. These anomalies are less obvious because our attention tends to be drawn to the cleft side, where form in this study appears less familiar.…”

“…19 Uncoupled growth of the premaxilla 20 results in an outward swing of the anterior nasal spine 19,21 with consequent deviation of columella and noncleft alar base away from midline. 19,21,22 Meanwhile, deficiency of the lesser segment 21 results in retrusion of the cleft alar base, 19,21,22 such that the orthogonal displacements result in a twisting collapse of the nose. 19 Using objective analysis of three-dimensional images, we have found that these changes occur in a dependent manner to the lateral deviation of the anterior nasal spine 19 and that the cleft alar base is normal in mediolateral position.…”

Trends of rhinoplasty research in the last decade with bibliometric analysis

“…Over the years, surgeons have been realizing that it is essential to know how nasolabial features change over time after the primary repair and subsequent surgical and orthodontic interventions, which provides references about residual deformities that may need further revision, and 3D anthropometric technology has been developed rapidly and widely used nowadays in cleft anthropometry (16). Series of longitudinal studies have been implemented according to different interventions (17)(18)(19)(20). Cluster 2 mainly concentrates on functional rhinoplasty.…”