Nasal asymmetry changes during growth and development in 6‐ to 12‐year‐old children with repaired unilateral cleft lip and palate: A 3D computed tomography analysis

Abstract

Repaired unilateral cleft lip and palate (UCLP) is often accompanied by the deformity and asymmetry of the nasal region. Three‐dimensional analysis was performed to investigate the relationship between nasal soft‐ and hard‐tissue asymmetries, as well as the changes in nasal asymmetry with age, among children with repaired UCLP (age: 6–12 years). Forty‐seven patients were included in this study. Their computed tomography records were retrieved for analysis of the 3D asymmetry of 10 landmarks of the nasal soft and hard tissues. We observed that asymmetry was more severe in nasal hard tissues than in soft tissues, particularly in the sagittal dimension. Compared with patients aged 6–9 years old, patients aged 10 to 12 years old had significantly increased vertical asymmetry at the base of the alar groove (Gbase, p = 0.027) and the lateral point of the piriform aperture (LPA), ( p < 0.001). The correlation between the LPA and the alar region was weak to moderate ( r = 0.290 to 0.488). In conclusion, we found no evidence of growth and development in nasal hard‐tissue asymmetry among 6‐ to 12‐year‐old children with repaired UCLP, except for the vertical dimension. Nasal soft tissue exhibited a more preferable symmetry than hard tissue, and this could be attributed to the compensatory growth of nasal soft tissue, particularly in the vertical and sagittal dimensions. The weak to moderate correlations between nasal soft‐tissue asymmetry and hard‐tissue asymmetry were observed in the three dimensions. Surgeons should consider these factors when repositioning the nasal alar and controlling the size of the nostrils.

Correlation Study between Levels of Gastrin, Serum IGF-1, and GHBP and Growth and Development in Children with Short Stature Based on Big Data Analysis

“…Gastrin is a peptide hormone released into the blood by the secretion of gastric fundus, with the element of 28 amino acids [ 21 ]. After acylation, it is able to combine with the growth hormone secretagogue receptor to across the blood-brain barrier, which is the only known hormone in the blood to stimulate appetite, with an unclear mechanism on promoting the GH secretion.…”

Success Rate of Mid-Secondary Alveolar Cleft Reconstruction Using Anterior Iliac Bone Grafts: A Retrospective Study

“…This study did not evaluate nasal morphology, symmetry, and nostril support following alveolar bone grafting. Even though positive effects of bone graft on nasal symmetry and support have been reported in several studies,[ 13 14 15 ] a contrary publication suggested that mixed-dentition alveolar bone grafting appears to have no significant long-term effect on nasal morphology, symmetry, or nostril shape. [ 16 ]…”

Growth patterns of the nasolabial region following unilateral cleft lip primary repair

“…According to the anthropometric principle of Farkas, the malposition of the alare base has always been represented by the subalare ( 15 , 27 , 28 ). Traditional perspectives revealed that for a unilateral cleft lip, lateral and inferior deviation of the cleft alar base led to deformities.…”

“…These nasal changes might be attributed to the re-establishment of the muscle balance on both sides. After that, the nasolabial angle and columella could be corrected by growth and development ( 10 , 28 ). Since there was a lack of muscle in the area near the nasal tip, this region was susceptible to scar contracture, which resulted in a downward rotation of the columella and the nasal tip.…”

“…At 12 months of age, the symmetry of the nose ameliorates, with the remnant asymmetry observed on the nostril rim ( 41 ). In patients aged 6–12 years after primary repair, the nasal soft tissue exhibits a better symmetry than the hard tissue, and this could be attributed to the compensatory growth of the nasal soft tissue, especially in the vertical and sagittal dimensions ( 28 ). It is also believed that at this age, despite the nasal symmetry being close to “normal,” the asymmetry persists in most patients ( 23 , 42 ).…”