Observation of Nasal Morphology in Unilateral Microform Cleft Lip Repaired by a Hidden Skin Incision.

BACKGROUND: Microform cleft lip is the mildest type of cleft lip without obvious defects of the upper lip. The nose deformities of microform cleft lip include flattened nostril rim, alar base asymmetry, and septal deviation. A hidden skin incision with nasal base muscle reconstruction was introduced in nose deformities of microform cleft lip. METHOD: To investigate the operative effect, we reviewed 21 patients with microform cleft lip treated with a hidden skin incision with nasal base muscle reconstruction from May 2020 to October 2022. Photogrammetric nasal morphometric measurements were compared preoperatively and six months postoperatively. The proportional value was obtained from the cleft and the noncleft sides, and paired t-test analysis was used to evaluate the surgical outcome. RESULT: Significant differences were found in all nasal morphologic measurements at 6 months postoperatively compared to preoperatively (p < 0.05). After surgery, the alar base and nostril were narrowed, while the lateral lip height was increased on the affected side. The height of the nostrils on the affected side was increased, and the nasal columella deviation was released. In addition, the ratio of the cleft-to-noncleft nostril area was closer to 1.0 after surgery. CONCLUSION: The unilateral microform cleft lip nasal deformity can be repaired through a small hidden incision. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical Characterization of the Tear Trough and the Lid-Cheek Junction: An Iodine Staining Technique Based on High-Resolution Micro-Computed Tomography.

BACKGROUND: The literature presents the tear trough and lid-cheek junction's controversial anatomical explanations. In this study, the authors explored the anatomical characterization of the tear trough deformity and lid-cheek junction. METHODS: Twelve human cadaver specimens were obtained from the authors' anatomy department. Iodine staining and high-resolution micro-computed tomography was used to observe the suborbital area's anatomy. Anatomical studies and histologic evaluation were performed. RESULTS: The orbicularis retaining ligament is composed of a main septum right on the rim and multiple fibrous septa in the retro-orbicularis plain. The septum arises from the deep fascia of the palpebral part of the orbicularis oculi at approximately the level of the medial corneoscleral limbus, anchors the muscle to the orbital rim, and continues laterally as the lateral orbital thickening at the lateral canthus. Along the lid-cheek junction, multiple fibrous septa emanating from the deep fascia of the orbital part of the orbicularis oculi converge to the above septum. Using three-dimensional simulation, the skin-insert junction between the pre-palpebral part of the orbicularis oculi and pre-orbicularis oculi fibers precisely corresponded with the tear trough and the lid-cheek groove. Anatomical studies and histologic evaluation confirmed these observations. CONCLUSIONS: The orbicularis retaining ligament's subtle anatomical features are clearly seen using the approach described. The tear trough and the lid-cheek junction's anatomical characterization is defined by a suborbital ligament-fascia system whose description has implications in designing lower eyelid cosmetic surgery.

In-Depth Volumetric Analysis of Alveolar Cleft Defects Using Three-Dimensionally Printed Models.

Presurgical evaluation of the alveolar cleft defect is an essential and crucial step for procedural success. In this study, three-dimensionally printed models derived from computed tomography scans were used to measure the alveolar defect volume before bone grafting. The authors also explored the influence of cleft type, age, and gender on alveolar bone defect volume. Ninety-four patients with unilateral alveolar cleft were enrolled in this study. One-way analysis of variance and multivariate analysis were used to investigate the influence of age (8-14 years), gender, and cleft type on the outcome of alveolar bone defect volume. The mean volume of the alveolar cleft defect in all patients was 1.40 ±â€Š0.37 ml, and the average age of the patients was 10.33 ±â€Š1.75 years. One-way analysis of variance showed that alveolar defect volume was not influenced by age (P = 0.24 > 0.05). Multivariate analysis indicated that gender (P = 0.001 < 0.05) and cleft type (P = 0.028 < 0.05) had a statistically significant influence on alveolar defect volume. This study validates our clinical experience and further proves the importance of individualized presurgical volumetric assessment in achieving optimal therapeutic outcomes.

Quick Method for Presurgical Volumetric Analysis of Alveolar Cleft Defects.

Presurgical evaluation of the alveolar cleft defect is an essential and crucial step for procedural success. This study proposes a method for rapid and precise volumetric assessment of alveolar cleft defects using computed tomography data and computer-aided engineering (CAE) software. For comparison, 3-dimensional-printed models of the alveolar bone were also made. A simulated graft was used on the models and the graft volume was measured using the water displacement technique. We then compared the CAE software-derived volumes with the actual volumes of the simulated grafts. The intraclass correlation coefficient ranged from 0.95 to 0.97 (intraobserver) and 0.94 to 0.98 (interobserver), indicating a high level of reliability and reproducibility of the CAE measurements. The mean time spent to calculate an alveolar cleft defect volume was 8.4 minutes. The average volume of the simulated bone grafts of 3-dimensional-printed models was 1.39 mL, which was lower than the mean volume of 1.42 mL calculated using the CAE software. The paired Student t-test showed no statistically significant difference between the volumes derived from the 2 methods. This study demonstrates that this quick assessment method is a useful adjunct to busy clinical practice.

Assessment of Bone Formation After Secondary Alveolar Bone Grafting With and Without Platelet-Rich Plasma Using Computer-Aided Engineering Techniques.

The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) × 100%. The mean BF% was 42.54 ±â€Š9.32% in group A and 46.97 ±â€Š18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.

Comparison of Three-Dimensional Printing and Computer-aided Engineering in Presurgical Volumetric Assessment of Bilateral Alveolar Clefts.

This study aimed to evaluate 2 advanced methods for presurgical calculation of bilateral alveolar cleft defect volume using 3-dimensional (3D) printing and computer-aided engineering (CAE) software. Twelve patients with bilateral alveolar cleft (4 females, 8 males, age range 8-11 years) were enrolled in the study. All patients underwent preoperative helical computed tomography scans, and the digital imaging and communications in medicine (DICOM) data of the computed tomography images were analyzed using 3D printing and CAE software. The 3D-printed model used a simulated graft, and graft volume was measured by water displacement. The CAE software used a subtractive method to calculate volume. Simulated graft volumes and CAE-software-derived volumes were compared using Pearson's correlation test and paired Student's t-test. The average volume of the simulated bone grafts obtained using 3D-printed models was 1.45 mL, which was lower than the CAE-software-derived mean volume of 1.52 mL. The mean calculation time using the 3D-printed model was 51.5 minutes, which was 32.1 minutes longer than the average 19.4 minutes when using CAE software. Paired Student's t-test revealed no statistically significant difference between the volumes derived from these methods. The results of this study further validated the use of 3D printing and CAE technique in bilateral alveolar defect repair. The CAE software is more cost-effective in presurgical volumetric assessment. Moreover, 3D models overcome limitations of 3D visualizations by providing tactile feedback and superior appreciation of visuospatial relationships among anatomical structures.