Changes in nasal profile after maxillary advancement in cleft and non-cleft patients

Based on 25 cases with unilateral clefts of lip, alveolus and palate with retromaxillism (CLAP) and 25 cases with pure retromaxillism (RM) the effect on the nose of advancing the maxilla by a Le Fort I osteotomy is analyzed. It can be shown that on average the base of the nose which is at the same time the base of the upper lip, follows the base of the maxilla in the ratio of 4 : 7 while the nasal tip is advanced in a ratio of 2 : 7. This means that to achieve a specified advancement of the nasal base, the maxilla has to be brought forward about twice this amount. A planned advancement of the tip of the nose can, on average, only be obtained by an advancement of the maxilla by three times this amount. The tangent to the columella is tilted considerably forewards and upwards. The movement is a little more marked in CLAP than in RM. The amount of maxillary advancement influences the ratios very little. It seems that they are slightly better after significant advancement. Leaving the nasal spine intact and tilting the maxilla forwards and upwards have a favourable influence on the advancement of the nasal tip. There is no satisfactory explanation of why the extremes in all groups for all measurements are placed so very far apart. As was found in the evaluation of lip movements (Freihofer 1976) this leads to the conclusion that in spite of careful planning the result in the individual case can differ considerably from that expected.