Objective evaluation of the Tajima secondary cleft lip nose correction.

The early and late results of the Tajima cleft nose correction were objectively measured by computer on 24 unilateral complete cleft lip and palate patients (age range 5-29 years, median 14). Follow-up records were divided into early (within 3 months), intermediate (3 months to 1 year) and late (1 year+); the longest follow-up was 4.2 years. Comparison of the preoperative records with the early and intermediate follow-up photographs showed an improvement in symmetry (Wilcoxon signed rank, P < 0.01). In the late follow-up group the deformity recurred and the nasal shape could not be statistically separated from the preoperative appearance. A group of 25 normal control faces showed no changes, whilst 20 control cleft patients had some worsening of nasal symmetry over the same time scale. Analysis of the components of the corrected noses showed the best improvement (and later relapse) was in dome symmetry.

Primary repair of the unilateral cleft lip nose: completion of a longitudinal study.

The first 10 consecutive unilateral cleft subjects operated on in 1975 by a technique of primary cleft nose correction, developed by the author (HKM), were reviewed at ages 10 and 18. No further nasal surgery had been performed on these cases. The anteroposterior and inferior facial appearances of each of the cases have been published for evaluation. A computer-based method of measuring nasal asymmetry was used to objectively analyze the results and compare them with normal and cleft control faces that were age matched. The results support the observation that nasal growth of the cleft side of the nose is unaffected by early primary nasal surgery and that the vertical shortening of the nose by the alar lift technique is preserved into adult life. Residual nostril asymmetry from septal deviation persists into adulthood.

The morbidity of the free vascularised fibula flap.

Twenty patients who had undergone free vascularised fibula flap transfers were reviewed to determine the incidence of peri and postoperative complications. The mean follow-up was 3.2 years (0.2-10); 18 grafts were successful, but required 10 re-operations for complications including 5 haematoma evacuations and 3 bone grafts and plates for delayed or non-union. The two unsuccessful fibula grafts required 11 re-operations, the majority for infections and non-union. Technical details of the operative procedure are reviewed for their part in the complications.

A computer-aided method of measuring nasal symmetry in the cleft lip nose.

Objective assessment of the results of cleft lip and nose surgery is necessary to quantify differences between alternative surgical techniques. A previously described method of measuring facial asymmetry has been modified to allow a comparison of differently treated cleft noses (radical nasal correction versus no nasal correction). Standardised, inferior view photographs of 10-year-olds were obtained from patient records. These were projected, traced, digitised and analysed using a BBC microcomputer. A method of excluding the ill-defined nasal baseline by obtaining a mirror-image of the upper nasal perimeter is described. The method has a high degree of inter and intra observer reproducibility.

A comparison of computer versus panel assessment of two groups of patients with cleft lip and palate.

A computer-based system of assessing asymmetry was used to compare standardised photographs of primarily corrected cleft noses, uncorrected cleft noses and control (normal) noses. A significant difference was found between control and cleft groups for both upper nasal perimeter (p < 0.001) and nostril outline (p = 0.001), and between uncorrected and corrected noses for upper nasal perimeter (p = 0.03) but not for nostril outline (p = 0.99). Comparing the results achieved by panel assessment (Cussons et al., 1992) with this of the same patients revealed some discordance related to the influence of extraneous factors on panel decisions. Panel assessment is needed in the evaluation of overall appearance, whilst the computer method is able to assess the results of different techniques, and from different centres, on specific features where symmetry is a major objective of surgical technique.

A computer-based method of measuring facial asymmetry. Results from an assessment of the repair of cleft lip deformities.

The appearance of the nose, mouth and nostrils was analysed in two series of unilateral, complete cleft lip patients. A programme was written for use on a BBC microcomputer to measure the symmetry of facial features traced from photographs. Symmetry was measured using one of two methods: determining the area of non-overlap when one side was reflected on the other (area method) or calculating the distance from regularly spaced points on the outline of one side to the nearest point on the reflection of the opposite side (curve method). The rankings of the photographs based on these results were compared with the subjective rankings given by a lay panel. The results based on the curve method agreed well with the subjective rankings (P for Spearman Rank Correlation Coefficients = less than 0.02). The technique provides a cheap, simple and quick method of comparing symmetry in groups of patients.