Difference in nasolabial features between awake and asleep infants with unilateral cleft lip: Anthropometric measurements using three-dimensional stereophotogrammetry.
OBJECTIVE
Cleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia.


METHODS
Three-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant.


RESULTS
In the supine position under general anesthesia, alar surface distance was significantly shorter (p < 0.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (p < 0.05 and p < 0.05, respectively), whereas vermilion height was greater (p < 0.01). In addition, the cleft width and lip width were significantly broader (p < 0.001 and p < 0.001, respectively) after general anesthesia.


CONCLUSIONS
Several nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan. Electronic address: dmorioka@gmail.com.
Daichi
D
Morioka
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Nobuhiro
N
Sato
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Taro
T
Kusano
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Hideyuki
H
Muramatsu
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Yasuyoshi
Y
Tosa
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Fumio
F
Ohkubo
Department of Plastic and Reconstructive Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8866, Japan.
Shinya
S
Yoshimoto
D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008046:Lip / Q000601:surgery; D009666:Nose / Q000601:surgery; D010780:Photogrammetry / Q000379:methods*; D016683:Supine Position / Q000502:physiology*
Cleft lip; General anesthesia; Muscle relaxation; Position; Three-dimensional anthropometry