ABSTRACT
BACKGROUND: Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry. PATIENTS AND METHODS: A controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft. Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles measurement. RESULTS: Group 2B patients showed significantly better shape and symmetry of nasal tip, size and symmetry of nostrils and size, form and lateral displacement of the ala. Objective evaluation showed that group 2B had the closest results to the non-cleft side, with statistically significant difference, when compared to other groups. CONCLUSION: Dissection and repair of both origin and insertion of nasalis muscle produced a nasal width, columellar height, and nasal tip projection close to the normal population of the same age.
Subject(s)
Cleft Lip/surgery , Facial Muscles/surgery , Female , Humans , Infant , Male , Treatment OutcomeABSTRACT
Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.
