title: Three-dimensional computed tomographic analysis of the maxilla in unilateral cleft lip and palate:  implications for rhinoplasty.
abstract: BACKGROUND
  The cleft lip nose is a complex 3-dimensional (3D) midfacial soft tissue and bony deformity. The contribution of maxillary hypoplasia to the etiology of this deformity has often been implicated for the suboptimal results of surgical treatment. The dimensions of the maxilla in unilateral cleft lip and palate (UCLP) have not been studied especially in relation to the volumetric and other asymmetries on the either side in unilateral clefts. The purpose of this article is to assess the relevant maxillary parameters of length, width, height, depth, and volume in patients with UCLP and compare the parameters of the cleft and noncleft sides.
  
  
  METHODS
  Fifteen patients with UCLP were treated by a standard protocol by a single surgeon and orthodontist. The measurements of maxilla were taken using a combination of axial, coronal, lateral, and 3D reconstructed images. The volume of each maxilla was calculated on 3D reconstructions using the technique of manual segmentation, which allowed complete reconstruction of the right and left maxilla individually.
  
  
  RESULTS
  In general, the cleft maxillary length, width, height, depth, and volume have been found to be reduced when compared with the normal sides with significant P values (Wilcoxon signed rank test Z, P < 0.001).
  
  
  CONCLUSIONS
  The study demonstrates the anatomy of the maxillary asymmetry existing in UCLP and underlines the importance of correcting the bony deficiency by appropriate techniques to harmonize the results of rhinoplasty in unilateral cleft lip nose deformity. Augmentation of the deficient maxilla by specific contoured bone grafts allows restoration of the symmetry of the nasal platform in unilateral cleft lip nose deformity.
authors.affiliation: Department of Plastic Surgery, C.S.M. Medical University, Lucknow, India. drrajivagarwal@gmail.com
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.forename: Anit
authors.initials: A
authors.lastname: Parihar
authors.forename: Pallavi Aga
authors.initials: PA
authors.lastname: Mandhani
authors.forename: Ramesh
authors.initials: R
authors.lastname: Chandra
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002972:Cleft Palate / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005146:Facial Asymmetry / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D008437:Maxilla / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery*; D009666:Nose / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012225:Rhinoplasty / Q000379:methods*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome