Resultados de la técnica septum bisagra en desviación de la punta nasal

Introducción: La desviación de la punta nasal suele producir alteración estética y funcional nasal. Generalmente, asocia alteraciones morfológicas de los cartílagos alares, además de dismorfia del cartílago septal. Objetivo: Presentar una técnica quirúrgica alternativa para el tratamiento de la laterorrinia en tercio inferior nasal y sus resultados. Material y Método: Se trataron 27 pacientes con una laterorrinia en punta nasal con la técnica del septum bisagra, incluyendo la colocación de uno o dos injertos de expansión. Describimos el protocolo de anamnesis y exploración que seguimos en estos pacientes y la descripción detallada de la técnica quirúrgica. Resultados: En 19 pacientes se utilizó un injerto de expansión unilateral para completar la técnica y en ocho de forma bilateral. Se obtuvo una puntuación media en la escala visual analógica (EVA) de ventilación de 8,3, con una mejoría de seis puntos, y en la EVA de aspecto estético de 8,1, mejorando en 4,6 puntos. Conclusión: la utilización de la técnica del septum bisagra es beneficiosa para el tratamiento de la desviación de la punta nasal, tanto a nivel funcional como estético. Presenta ciertas diferencias frente a otras técnicas descritas. La indicación se debe adecuar a cada paciente de manera individualizada.

Introduction: Deviation of nasal tip usually produces aesthetic disturbance and nasal ventilation decrease. It is usually associated with alar cartilages morphologic disturbances and dysmorphia of the septal cartilage. Aim: To present an alternative surgical technique for treating laterorrhinia in the nasal inferior third and its outcomes. Material and Method: 27 patients with nasal tip laterorrhinia were treated with the hinge septum technique, including the placement of one or two spreader grafts. We describe the anamnesis and exploration protocol that we carried out in these patients and a detailed description of the surgical procedure. Results: Unilateral spreader graft was used in 19 patients to complete the technique, and bilateral spreader graft was used in eight. The average score in visual analogue scale (VAS) related to nasal flow was 8.3, which means an improvement of six points, and in VAS related to aesthetic appearance the score was 8.1, improving 4.6 points. Conclusion: The use of the hinge septum technique is useful to treat the deviation of the nasal tip in a functional and aesthetic way. There are several differences compared to other described techniques. The indication has to be suitable for each patient individually.

The application of diced cartilage in postoperative nasal deformity of cleft lip surgery / 中华整形外科杂志

Objective@#To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery.@*Methods@#A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated.@*Results@#The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up.@*Conclusions@#The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.

A Case of Saddle Nose Deformity Caused by Electrocautery of Nasal Septum / 대한이비인후과학회지

Electrocautery of nasal septum is a very common treatment of epistaxis in Otorhinolaryngology. However, serious complications of electrocautery are rare. We encountered a 52-year-old female patient who presented with nosebleeds. A definite focus of bleeding was identified by nasal endoscopy, thus electrocautery by bipolar diathermy was performed in the area of Kisselbach's plexus of nasal septum. There were no abnormal findings in the nasal septum during the three weeks of outpatient visit. However, the patient noticed a depression near the tip of her nose 12 weeks later. Saddle nose deformity after electrocautery has not yet reported in the literature. Therefore, we present this case with a brief review of literature.

Correction of deviated nose

Deviated nose deformities have always been a surgical challenge, and it is essential to achieve both functional and esthetic improvements. Various techniques have evolved over time to correct deviated noses but no one method applies in all cases. Successful correction requires a complete understanding of the various surgical techniques and concepts, including the three-dimensional nasal structure and the time-related changes to surgically-treated noses.

Saddle Nose Deformity as a Result of an Aseptic Nasal Abscess Accompanied by Ulcerative Colitis and Pyoderma Gangrenosum

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes granulomatous inflammation in the mucous membrane of the intestinal tract, especially in the colon. Additionally, UC can be accompanied by extraintestinal manifestation (EIM). EIM of UC includes cutaneous lesions such as pyoderma gangrenosum, and rarely, systemically occurring aseptic abscesses (AA) have been reported in a few cases. Nasal involvement of UC as an extraintestinal manifestation of IBD is rare, and few reports of nasal mucosa and septal cartilage involvement have been documented in the literature. However, aseptic nasal abscess involving septal cartilage associated with UC and pyoderma gangrenosum resulting in saddle nose deformity have not been reported. The author presents a case of a 52 year-old woman with UC and pyoderma gangrenosum and an aseptic abscess in the nasal septal cartilage resulting in saddle nose deformity, which was corrected by augmentation rhinoplasty.

Correction of Tilted Cartilaginous Nasal Dorsum with Clocking Suture Single Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Deviated nose is a commonly encountered deformity, and the correction of deviated nose is the most difficult part of septorhinoplasty. Generally, additional cartilaginous graft is required for straightening the deviated segment. However, there are many cases where sufficient cartilage grafts are not available due to revision surgery or cases with small cartilage. In such cases, tilted cartilaginous dorsum should be corrected without grafting. The purpose of this study is to evaluate the usefulness of clocking suture single technique for cartilaginous deviation by analyzing the surgical results of cases who underwent corrective rhinoplasty without any cartilaginous graft. SUBJECTS AND METHOD: From June 2009 to June 2016, 43 patients with tilted cartilaginous dorsum were corrected with clocking suture single technique. Cases underwent additional graft for straightening dorsum were excluded. The patients' medical records and facial photographs were analyzed to assess surgical outcomes and complications. Surgical outcomes were graded as excellent, fair and poor according to patients' satisfaction and evaluation by two physicians. RESULTS: Mean follow up period was 15.4 (5-39) months. There were 39 patients (90.7%) with excellent result, 3 patients (7.0%) with fair results, and 1 patient (2.3%) with poor result. Augmentation was performed with expanded polytetrafluoroethylene or septal cartilage in 26 patients (60.5%) and dorsal hump was removed in 22 patients (51.2%). Concomitant augmentation didn't affect surgical results. No postoperative complication such as infection or inflammation were found. CONCLUSION: The clocking suture single technique is an effective surgical method for the correction of dorsal cartilaginous deviation.

Nasal Bone 3 Dimentional Computer Tomography Guided Tailored Osteotomy of the Bony Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Correction of deviated nose is considered one of the most difficult and serious surgical operations in rhinoplasty. The correction of bony deviation, in particular, requires osteotomy. Although there are individual differences in the shapes or features of bony deviations of each patient, the techniques of osteotomy are limited. Therefore, for proper correction of bony deviation, it is necessary to set up a precise pre-surgical plan. SUBJECTS AND METHOD: We categorized 187 patients with bony deviated nose into 5 types based on the analysis of preoperative nasal bone 3D computer tomography, and studied surgical method for each type. RESULTS: Of 187 patients, 92 (49%) patients are categorized into type I, 62 (36%) patients into type II, 12 (6%) patients into type III, 2 (1%) patients into type IVa, 7 (4%) patients into type IVb and 7 (4%) patients into type V. Only did eight patients (5%) undergo revision surgery due to unsuccessful outcomes. Major complications like infection, abscess, arteriovenous fistula, epiphora, and saddle deformation did not occur at all. CONCLUSION: Preoperative planning under the analysis and categorization using 3D CT is considered helpful for the precise and individualized surgery in corrective rhinoplasty.

Fisura nasal-labial unilateral / Unilateral cleft nose-lip deformity / Fisura naso-labial unilateral

Este es un trabajo descriptivo que realiza una puesta al día sobre la resolución quirúrgica de los defectos estético-funcionales de la nariz leporina unilateral. Para cumplir con el objetivo realizamos una revisión bibliográfica con especial enfoque en: embriología, anatomía, técnicas quirúrgicas y cronogramas de tratamientos recomendados. Como agregado final presentamos la técnica quirúrgica utilizada por los autores y 3 casos operados.

This is a descriptive study which performs an updateon the surgical resolution of the aesthetic-functionaldefects of unilateral cleft nose-lip deformity. Tomeet the goal we conducted a literature review withspecial focus on: embryology, anatomy, surgical techniquesand schedules recommended treatments. As an added end we present the surgical techniqueused by the authors and operated cases.

É um trabalho descritivo que realiza uma atualização sobre a resolução cirúrgica dos defeitos estético-funcionais do nariz leporina unilateral. Para atingir o objectivo realizamos uma revisão da literatura com enfoque especial na: embriologia, anatomia,técnicas cirúrgicas e tempos dos tratamentos recomendados. Também apresentamos a técnica cirúrgica utilizada pelos autores e três casos operados.

Corrective Rhinoplasty with Combined Use of Autogenous Auricular Cartilage and Porcine Dermal Collagen in Cleft Lip Nose Deformity / 대한악안면성형재건외과학회지

Esthetic reconstruction of cleft lip nose deformity is a challenging task in surgical management of patients with orofacial cleft. The author reconstructed cleft lip nose deformity effectively using autogenous auricular cartilage and a relatively new graft material of porcine dermal collagen, Permacol(TM). After correction of the deformed lower third of the nose with patient's auricular cartilage, we applied Permacol(TM) to augment the entire nasal dorsum. Three patients were treated and followed for up to five years. All patients improved in nose aesthetics without any inflammatory or immunogenic reaction. The author suggests that the use of Permacol(TM) for nasal profile augmentation in the treatment of cleft lip nose deformity is an alternative surgical strategy with minimal surgical invasiveness. The author report long-term experience with combined use of auricular cartilage and Permacol(TM) in nasal reconstruction for cleft lip nose deformity.

Tailored Correction of Deviated Nose / 대한이비인후과학회지

The correction of deviated nose is the most challenging step among various procedures of rhinoplasty. Many effective surgical methods for correction of bony and cartilaginous deviation have been developed since the beginning of rhinoplasty, however it is not easy to choose appropriate surgical method for each patients. Surgical procedure should be personalized depending on patients' characteristics of nasal framework and covering skin, therefore same method cannot be applied to all patients. Size, strength and thickness of bony and cartilaginous structure, thickness of skin, existence of nasal hump are the essential components which should be considered. Surgical method for correction of deviated nose cannot be applied uniformly to patients, and should be tailored to individual patient. For this reason, rhinoplasty surgeon should be skilled at various techniques of corrective rhinoplasty.

Correction of Retracted Ala Using Spacer Graft in Secondary Cleft Lip and Nose Deformity

PURPOSE: In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. METHODS: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo. RESULTS: Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty. CONCLUSION: The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.

Nasal Reconstruction with Chondrocutaneous Preauricular Free Flap and Interpositional Vascular Graft: A Case Report

PURPOSE: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. METHODS: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. RESULTS: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. CONCLUSION: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.

Analysis of Cleft Lip Nose Deformities Correction in Adults: Detailed Techniques and Comprehensive Review

PURPOSE: Correction of cleft lip nose deformity(CLND) in adulthood is different from one in childhood. Usually correction of CLND is final surgery for adult patient who has cleft lip, so many things have to be considered for correction. Of course, it is different from common rhinoplasty, either. The adult patients can be corrected by complete rhinoplasty with various techniques. To recognize how rhinoplasty techniques was used for correction of CLND, authors analyzed detailed techniques which were selected in the adult patients for 10 years and reviewed comprehensive operation. METHODS: A retrospective review was conducted involving 64 patients with CLND who underwent surgery and aged after 14 years at operation between 2001 and 2010. Detailed techniques were investigated by medical record review and classified according to incision, septoplasty, osteotomies, correction of vault, tip plasty and etc. RESULTS: Except one, all patients were performed open rhinoplasty. 49 patients were performed septoplasty. 33 patients were performed complete rhinoplasty with osteotomies. Hump nose correction was performed for 10 patients. Dorsal augmentation was performed for 8 patients. And all patients were performed tip plasty. Tip plasty using suture technique was performed for 58 patients and graft was performed for 48 patients. CONCLUSION: Correction of CLND in adult is one of the most challenging and varied operation of plastic surgery. In this study, the majority of patients were performed complicated and delicated procedures. It seems to be because patient's demand level has been elevated and rhinoplasty procedures have been advanced. This study may help to planning of CLND correction.

Expansion Procedures of the Nasal Envelope in Short Nose Deformity : Release of the Transverse Nasalis Sling and Division of Muscle Confluence in Nasal Hinge Area

Cartilage extension and nasal envelop expansion play a main role incorrecting short or contracted nose. Despite numerous studies for cartilage expansion, there has been no reports of nasal skin elongation methods. We hereby preport a new method for expansion of nasal envelop with a comprehensive understanding of anatomical structures. From April 2009 to September 2010, 6 patients underwent operations to correct short or contracted nose. Two separating procedures were included for nasal envelop elongation; division of muscle(Procerus, Transverse nasali, Levator labii superior alaque nasi: PTL muscles) confluence located at nasal hinge and release of transverse nasalis sling. To estimate the degree of nasal envelop extension, forced skin traction test was performed. Comprehensive research with fresh cadaver was held to study the relationship between nasal SMAS and surrounding structures. Average 3.8mm elongation was documented by forced skin traction testafter the procedure. In the fresh cadaver study, transverse nasalis sling and PTL muscle confluence were firmly attached to the supportive framework. From our clinical experience and cadaver study, we discovered that release of transverse nasalis sling and division of PTL muscle confluence are the main factors for nasal envelop expansion in short or contracted nose.

Surgical Considerations for Effective Correction of Hump Nose in Asians

On the aesthetic surgical point of view, the hump nose characterized by nasal hump, straight or convex dorsal profile, drooping nasal tip and acute nasolabial angle results in strong and older facial image. To improve these hump nose in Asians, classical Joseph's nasal hump reduction or conservative humpectomy followed by nasal tip-plasty and augmentation rhinoplasty were applied according to hump size. However, these methods of hump nose correction are insufficient for satisfactory results due to unfavorable dorsal profile and hump recurrence. Therefore, the author presents systemic and important surgical considerations obtained by surgical experiences from more than 200 cases to produce consistent and complete correction of hump nose without recurrence. From April of 2004 to May of 2008, total 228 patients underwent hump nose correction recognizing surgical considerations presented in this research. Of these patients, 38 patients were secondary cases of hump nose due to unfavorable dorsal profile and hump recurrence. The author obtained aesthetically satisfactory results without recurrence for mean 17 months follow up periods in all patients without any significant surgical complications. Measurement results are as follows: 1.average decrease in nasal length was 3.4mm, 2. average decrease in nasal width was 2.2mm, 3. average increase in nasal tip projection was 4.3mm, 4. average increase of nasolabial angles was 12.2 degree. In conclusion, hump nose correction by recognizing surgical considerations presented in this research is an effective, reliable and valuable method in correcting hump nose without recurrence and improving lateral nasal profile aesthetically.

Surgical Correction of Nostril Base and Nostril Sill Depression in Unilateral Secondary Cleft Lip Nose Deformity

PURPOSE: Most unilateral secondary cleft lip nose deformities have depressed nostril base and sill on the cleft side. To obtain a symmetric nose, correction of the recession on nostril is critical. The authors have worked out effective methods to elevate the nostril of the cleft side according to the extent of the depression. METHODS: A total of 115 unilateral secondary cleft lip nose deformity patients with nostril depression were evaluated. Data were acquired from patients' charts and photography with special reference to the height difference of the nostrils between the cleft side and the non-cleft side. Patients were divided into three groups based on the difference and operated with various techniques :(1) mild degree( 3mm) with graft, C-flap and suspension suture. Follow-up period averaged 21.3 months. RESULTS: Forty-six patients(40 percent) were in mild group, and forty-two(37 percent) were in moderate. In twenty-seven patients(23 percent), nostril recession was more than 3mm. The elevated nostril base and sill were maintained without height alteration during follow-up. CONCLUSION: The symmetry of the nostril base, especially projection of nostril sill influences successful correction of unilateral cleft lip nose deformity. Our tolerable techniques can be applied to most deformities with nostril depression and can present a new guideline.

Quantitative Analysis of Lower Nose and Upper Lip Asymmetry in Patient with Unilateral Cleft Lip Nose Deformity using 3D Camera

PURPOSE: Analysis of lower nose and upper lip asymmetry in patients with unilateral cleft lip nose deformity has been proceeded through direct measurement and photo analysis. But there are limitation in presenting real image because of its 2 dimensional trait. The authors analyzed such an asymmetry using 3D VECTRA system (Canfield, NJ, USA) in quantitative way. METHODS: In 25 Patients with unilateral cleft lip nose deformity (12 males, 13 females, age ranging from 4 to 19), patients with right side deformity were 10 and left were 15. Analysis of asymmetry was proceeded through 3D VECTRA system. After taking 3 dimensional photo, alar area, upper lip area, nostril perimeter, nostril area ,Cupid's bow length, nostril height and nostril width were measured. Correlation coefficient and inter data quotients were calculated. RESULTS: In nostril perimeter, maximal difference of cleft side and non-cleft side was 39.3%, asymmetric quotient Qasy = Qcl/Qncl (Qcl, value of cleft side; Qncl, value of non-cleft side) ranged from 0.84 to 1.85 and in seven cases the length of cleft side was smaller. In nostril area, maximal difference was 69.6% and in 13 cases cleft side was smaller. In lower nasal area, maximal difference was 37.2% asymmetric quotient Qasy = Qcl/Qncl was ranged from 0.47 to 2.03 and in 20 cases cleft side was smaller. The correlation coefficients of nostril perimeter and area were 0.8345. CONCLUSION: Using 3D VECTRA system, the authors measured nostril perimeter and lower nasal area that could not been measured with previous methods. Asymmetry of midface was analyzed through area comparison in quantitative way. Futhermore, post operative change can be measured in quantitative method.

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.

Nasal Deformity and Acoustic Airway Obstruction Profiles in Unilateral Secondary Cleft Lip Nose Deformity

Patients with secondary cleft lip nose deformity usually complain not only aesthetic problems but also functional problems such as nasal obstruction. However, there have been few studies on nasal airway problem in secondary cleft lip nose deformity patients and no reports for the correlation between degree of the deformity and nasal airway obstruction. The authors selected 34 patients with secondary cleft lip nose deformity and measured the degree of morphological deformity by photo analysis and the degree of nasal airway obstruction by VAS score and acoustic rhinometry. Almost all patients complained of more obstructive symptom on the affected side. Functional anatomic structure and volume of the nasal airway examined by acoustic rhinometry showed that narrowest point was located above the nostril and pathological obstruction was more significant in patient group in both side and the area of the narrowest point and the total nasal volume was smaller in patient group. The result that alar contour difference has correlation with total nasal volume but not with objective symptom shows that there may be other factors affecting the nasal obstruction. Therefore the authors conclude that not only the correction of the external morphologic deformity but also the consideration of nasal airway obstruction is essential when performing operation on the secondary cleft lip nose deformity patients.

Objective Evaluation of Secondary Cleft Lip Nose Deformity by Analysis of Nostril Shape

Cleft lip is one of the most common congenital deformities in craniofacial region. However, despite many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome has been based on the subjective observation. Therefore, developing a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nasal deformity is important to improve the management of the cleft lip patients. The authors have proposed a new scoring model to evaluate objectively the nasal deformity. The authors put 'x' axis on the nostril sill of noncleft side and 'y' axis on nasal tip at a right angle to x axis. The nostril of noncleft side was turned around the y axis to form the mirror image on the cleft side, and following four parameters were recorded: (1) angle difference between two nostril axis, (2) center of the nostril and distance between two centers, (3) the overlapped area of two nostrils and (4) the overlapped area ratio of two nostrils. The post-surgery images were evaluated by the three plastic surgeons, using the scale of 5 percentiles. The four parameters of each image were measured using a newly developed software and correlation coefficients of each parameter and the evaluation scale by the surgeons were obtained. Among the scores from scoring model, errors greater than 10 percents were found only in 2 of 14 cases (2/14=14%), but among the scores from examiners, errors of greater than 10 percents were 4 from 14 cases (4/14=29%). Based on the results, deviation among the individual examiners can be reduced using the objective evaluation program developed in this study. The correlation coefficients between the normalized overlap area (0.78) and the distance between the centers of two nostrils (-0.82) with the evaluated scale by surgeons were high. However, the relative area and the degree difference of two nostril axis were found to be not such a good parameters in the evaluation of the nasal deformity. We developed scoring model from analysis of nostril shape and neural network which is able to evaluate cleft lip nasal deformity objectively after selection of proper parameters.