title: Changes in nose symmetry in unilateral cleft lip and palate treated by differing pre-surgical assistance: An objective assessment of primary repair.
abstract: BACKGROUND
  Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction.
  
  
  METHODS
  Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, ≤ 05 confidence.
  
  
  RESULTS
  Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p = 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p = 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p = 0.0015), nares "offset" (p = 0.002), and columella symmetry (p = 0.022) with nose-treatment achieving near ideal columella symmetry score (0.92) vs. (0.81).
  
  
  CONCLUSIONS
  NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.
authors.affiliation: UDM School of Dent, Dept. of Orthodontics, Detroit, MI, USA; Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Providence Hospital, Southfield and Novi, MI, USA; Orthodontics at 39611 Garfield Rd. - Suite 12, Clinton Twp, MI 48038, USA. Electronic address: spolyarjohn@yahoo.com.
authors.forename: John L
authors.initials: JL
authors.lastname: Spolyar
authors.affiliation: Division Craniofacial Plastic Surgery, Catholic Children's Hospital Wilhelmstift, Lilinecronstr. 130, Hamburg 22149, Germany; Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA.
authors.forename: J Camilo
authors.initials: JC
authors.lastname: Roldán
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055171:Nasal Cartilages / Q000473:pathology / Q000601:surgery; D009300:Nasal Septum / Q000002:abnormalities / Q000601:surgery; D009666:Nose / Q000002:abnormalities* / Q000473:pathology; D019637:Orthopedic Procedures / Q000295:instrumentation; D010158:Palatal Obturators; D010781:Photography / Q000379:methods; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods
keywords: DMA; Nasal molding; Orthopedics; Premaxilla; Presurgical; Septum