Photogrammetric Analysis of the Lip and Nose after Presurgical Infant Orthopedics in Unilateral Complete Cleft Lip and Palate

ABSTRACT

The purpose of this study is to evaluate the effect of the presurgical infant orthopedics and the nasoalveolar molding in unilateral complete cleft lip and palate by the analytic system using standardized photographs. This study involved 34 patients with unilateral complete cleft lip and palate(24 male, 10 female, mean age 4.9 years) who underwent a rotation-advancement flap repair between 1995 and 1998 by single surgeon. Follow-up photographs were taken at a time average 3.8 years(2-7ears) after surgery. The patients were divided into three groups Group I(9 patients) consists of those who underwent cheiloplasty and primary rhinoplasty without presurgical infant orthopedics. Group II(10 patients) consists of those who underwent cheiloplasty and primary rhinoplasty with presurgical alveolar molding alone without nasal molding, and Group III(15 patients) consists of those who underwent presurgical alveolar molding with nasal molding without primary rhinoplasty. Facial proportions and angles were measured on standardized photographs using defined anthropometric points. All linear parameters were converted to the percentage values. In addition, the qualitative measurements were performed on scar quality, nostril symmetry and alar symmetry. Comparisons between group I and II and those between group II and III were made in all parameters. Results were analyzed by Mann-Whitney/ Wilcoxon rank sum test. Between group I and II, there was a significant increase in upper lip height symmetry in group II(p= 0.014). Between group II and III, upper lip height symmetry and Cupid's bow length symmetry significantly increased in group II(p=0.002, p=0.012). The other quantitative and qualitative parameters didn't make the difference between groups. In conclusion, the infant orthopedics increases upper lip height of cleft side and has the effect to obtain the upper lip symmetry. But the nasoalveolar molding has no effect to increase the nasal symmetry. So the nasoalveolar molding alone appears to be insufficient to replace the infant orthopedics with primary rhinoplasty.