Nasal growth in complete bilateral cleft lip and palate

Forty-four lateral cephalograms from a sample of 15 white males with bilateral cleft lip and palate (BCLP) were evaluated to determine the growth pattern of the nose, identify timing of the nasal growth spurt, assess growth of the underlying bony elements relative to the nasal growth, and ascertain the relationship of the nose to the rest of the facial profile. The cephalograms (taken at ages 7.5 to 16.6 years) were divided into five groups according to age of subject. Fifteen variables related to soft tissue nose, nasal bone, maxilla, and facial convexity were assessed. Results of this investigation were as follows. First, the nose of subjects with BCLP grew more downward than forward. Second, the growth spurt occurred between the ages of 12 and 16 years. Third, forward growth of the nose was almost always found, whereas the maxilla becomes more retrusive. Fourth, the angle of soft tissue nasion (N')-pronasale (Prn)-soft tissue pogonion (Pog') had an average decrease of 3.56 degrees from age 8 to 16 years. Individual data showed that 12 of 15 patients had a decrease of this angle, whereas 3 had a small increase; 10 of 12 with a decrease demonstrated an increase of both sella-nasion (SN')-Prn and SN'-Pog'. The remaining 2 showed an increase of SN'-Prn and a decrease of SN'-Pog'. Thus, the profile of the nose (N'-Prn-Pog') became more convex over the observed period, which at least in part seemed to be due to the horizontal development of the nose itself.