title: Three-dimensional morphologic nasal surface characteristics that predict the extremes of esthetics in patients with repaired cleft lip and palate.
abstract: OBJECTIVE
  The purposes of this study were (1) to develop imaging methods and objective numeric parameters to describe nose morphology, and (2) to correlate those parameters with nasal esthetics for patients with clefts.
  
  
  METHODS
  A total of 28 patients with repaired complete unilateral cleft lip and palate (CUCLP) and 20 age- and gender-matched individuals without clefts were identified. A panel of orthodontists rated and ranked nasal esthetics from nose casts for the cleft group. Best and worst esthetic cleft groups were established from the cast assessments. Three-dimensional surface coordinates of the casts were digitally mapped with an electromagnetic tracking device. Digitized nasal images were oriented, voxelated, sliced, and mathematically curve-fitted. Maximum difference, percent area difference, and maximum and minimum derivative differences between cleft and noncleft and between right and left nose sides were calculated. Differences in parameters between groups were assessed with the use of analysis of variance (ANOVA) and t tests, and correlations with esthetics were assessed with the Spearman rank correlation test.
  
  
  RESULTS
  Differences were seen between cleft and noncleft and best and worst esthetic groups for all four parameters (p < .05). The best esthetic cleft group had (1) lower percent area difference (p < .0001), (2) lower maximum difference (p < .001), and (3) smaller differences in slope of the nose in the coronal plane (p < .0001) than the worst esthetic cleft group.
  
  
  CONCLUSIONS
  Maximum difference and maximum derivative difference and, to a lesser degree, percent area difference can be used to identify differences between cleft and noncleft nasal morphology and to assess levels of nasal esthetics for patients with CUCLP.
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Russell
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Milne
authors.forename: Devesh
authors.initials: D
authors.lastname: Varma
authors.forename: Keith
authors.initials: K
authors.lastname: Josephson
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D055590:Electromagnetic Phenomena; D004954:Esthetics; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional; D008297:Male; D008953:Models, Anatomic; D012225:Rhinoplasty; D012984:Software; D016896:Treatment Outcome