Three-Dimensional Soft Tissue Nasal Changes After Nasoalveolar Molding and Primary Cheilorhinoplasty in Infants With Unilateral Cleft Lip and Palate

Mancini, Laura; Gibson, Travis L.; Grayson, Barry H.; Flores, Roberto L.; Staffenberg, David A.; Shetye, Pradip R.

doi:10.1177/1055665618771427

Cited by 33 publications

(50 citation statements)

References 31 publications

(32 reference statements)

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“…However, only a few studies have used (3D) stereophotogrammetry for evaluation of facial growth and treatment outcome in infants with OFCs until 12 months of age. Two studies used linear and angular measurements for evaluation of facial morphology before and after primary lip closure (Alazzawi et al, 2017; Morioka et al, 2018), and one study also made a comparison with the facial morphology of a control sample (Mancini et al, 2018). Furthermore, one study used superimposition of individual 3D images for evaluation of facial morphology before and after nasoalveolar molding and primary cheilorhinoplasty (Wu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

Brons

Meulstee

Loonen

et al. 2019

PeerJ

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Background Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. Methods Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children’s reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed. Results Assessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5–5 mm posterior to those in the average controls. Conclusion In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.

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Section: Introductionmentioning

confidence: 99%

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

Brons

Meulstee

Loonen

et al. 2019

PeerJ

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“…This observational time interval is not a long-term result, but overall we and others achieved good short-term results. 15 Mancini et al reported improved nasal projection, nasal width and nasal symmetry, and columella length in a 3D analysis of 20 consecutively treated cases with UCLP. Barillas et al reported that the good results were maintained at least until the age of 9 years.…”

Section: Discussionmentioning

confidence: 99%

Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM

Wolff

Grill

Ritschl

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Long-term results and efficacy of nasoalveolar molding (NAM) on the perinasal region are reported controversially in the literature. With this study, we demonstrate our experiences, contribute to the ongoing discussion, and describe our decision-making when NAM is indicated or not. Methods: Conventional pre- and postinterventional photographs of patients with nonsyndromic unilateral and bilateral cleft lip and palate (UCLP and BCLP) were analyzed. The 2 independent raters were blinded to therapy (NAM versus non-NAM), and 7 parameters were measured. Intraclass correlation coefficient for intra- and interrater reliability was calculated. The Mann–Whitney U test was performed to compare therapy- and appearance-matched pairs. Finally, 30 specialists in cranio-maxillofacial surgery performed a subjective, blinded rating of matched NAM and non-NAM cases. Results: Thirty-six patients, 16 UCLP and 20 BCLP, were enrolled. The intraclass correlation coefficients for intra- and interrater reliability were excellent for all measurements, except for nasal sill (0.77 intrarater and 0.80 interrater). Height-to-width ratio (P = 0.012) was significantly different in the comparison of non-NAM and NAM-treated severe cases with UCLP. Thirty blinded raters evaluated NAM-treated cases with severe UCLP better than matched non-NAM cases. Non-NAM-treated cases with moderate UCLP and BCLP were rated better than matched NAM cases. Conclusions: Children with severe UCLP may benefit from NAM therapy in the sense of better symmetry and a more homogenous appearance. Patients with moderate UCLP and BCLP did not benefit, and the risk of the burden of care increased.

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“…This allowed for the opportunity to enlarge and rotate the digital models in all the 3 planes (Bootvong et al, 2010) including the vertical plane—as there is a tendency in the cleft deformity that the alveolar ridges grow or move in vertical direction when there is no supporting vector present on the vertical direction. Furthermore, 3-D anthropometric assessment have proven to superior in the overall of the naso-labial and alveolar outcome assessment post-NAM in patients with CLP when compared to 2-D assessments (Chou et al, 2017; Singh et al, 2005; Singh et al, 2007; Mancini et al, 2019). While our 3-D assessment has been primarily focused on the cast based changes, given that the findings of our study are in line with the abovementioned studies with regard to nostril width (similar decrease), height (comparable increase), and columellar axis change (equivalent increase), a more detailed 3-D assessment of the facial changes including those from the profile view would be interesting to assess.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Presurgical Infant Orthopedics by Modified Grayson Method and Dynacleft With Nasal Elevators in Patients With Unilateral Cleft Lip and Palate—A Clinical Prospective Study

Abhinav

Batra

Sood

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To compare the effects of presurgical infant orthopedics using 2 different methods, that is, the Dynacleft with Nasal elevator system versus the modified Grayson’s technique in patients with complete unilateral cleft lip and palate. Design: Prospective comparative cohort study. Materials and Methods: Twenty-eight patients were divided into 2 groups, that is, Group A consisting of 14 patients who underwent correction with DynaCleft with Nasal elevator system and Group B consisting of 14 patients undergoing correction using the modified Grayson technique. Maxillary cast measurements were taken at 2-time intervals (pre- and posttreatment) to assess various parameters using a laser scanning machine (C500 Solutionix) and 3D software (GOM Inspect). Similarly, standardized anterior–posterior and worm’s-eye view photographs using a custom box were taken and imported to Adobe Photoshop CS6 for measurements. Paired t test and independent t test were used to compare intra- and intergroup changes, respectively. Results: The analysis of cast (primary outcome) and photographic (secondary outcome) measurements showed improved nasal asymmetry and alveolar correction in both groups which showed no significant intergroup difference when assessed using the independent t test ( P > .05). Group A showed higher chances (42.8%) of causing a T-shaped defect (due to excessive mesial-inward rotation of the minor segment) when compared to the Group B possibly due to a more controlled molding vector ( P < .05). Conclusion: Both methods proved effective in improving the nasal asymmetry, reducing the alveolar cleft gap, and approximating the lips together; but care must be taken when applying the alveolar molding vector in the Dynacleft system.

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Three-Dimensional Soft Tissue Nasal Changes After Nasoalveolar Molding and Primary Cheilorhinoplasty in Infants With Unilateral Cleft Lip and Palate

Cited by 33 publications

References 31 publications

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces

Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM

Comparative Study of Presurgical Infant Orthopedics by Modified Grayson Method and Dynacleft With Nasal Elevators in Patients With Unilateral Cleft Lip and Palate—A Clinical Prospective Study

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