Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven...

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Plastic Surgery

Background:

• Current descriptions of unilateral cleft lip and nasal deformity (uCLND) lack objective data and are inconsistent.
• Theoretical models of uCLND have not been empirically tested.
• Improved understanding of uCLND is crucial for developing more effective surgical treatments.

Purpose of the Study:

• To develop a data-driven, three-dimensional (3D) model of unilateral cleft lip and nasal deformity (uCLND).
• To characterize the spectrum of uCLND presentation and identify underlying mechanisms.
• To provide an objective basis for refining surgical objectives in uCLND treatment.

Main Methods:

• Analysis of 3D images from 100 infants with unrepaired cleft lip at 6 months of age.
• Objective assessment using landmark positions, anthropometric dimensions, and shape-based measures.
• Stratification of cleft severity by subnasale displacement to develop a linear regression model.

Main Results:

• Progressive subnasale deviation correlated with lateral movement of the non-cleft alar base and posterior positioning of the cleft alar base.
• Observed a nasal dorsum deviation towards the non-cleft side, following the caudal septum.
• Identified significant alterations including cleft alar dome collapse, non-cleft alar ring constriction, and philtrum displacement.

Conclusions:

• The study validates theoretical models of uCLND and elucidates specific vectors of change.
• Significant alterations on the non-cleft side of the nose were identified.
• Treatment objectives should focus on columella and philtrum centralization and nasal rebalancing through correction of alar base displacement.