title: Nasal Airway Dysfunction in Children with Cleft Lip and Cleft Palate: Results of a Cross-Sectional Population-Based Study, with Anatomical and Surgical Considerations.
abstract: BACKGROUND
  The aesthetic aspects of the cleft lip nasal deformity have been appreciated for over a century, but the functional implications have remained largely underappreciated or misunderstood. This study describes the frequency and severity of nasal obstructive symptoms among children with cleft lip and/or cleft palate, addressing the hypotheses that age, cleft type, and severity are associated with the development of nasal obstructive symptoms.
  
  
  METHODS
  Children with nonsyndromic cleft lip and/or cleft palate and a comparison group of unaffected children born from 1997 to 2003 were identified through the North Carolina Birth Defects Monitoring Program and birth certificates. Nasal airway obstruction was measured using the validated Nasal Obstruction Symptom Evaluation scale.
  
  
  RESULTS
  The survey was completed by parental proxy for 176 children with cleft lip and/or cleft palate and 333 unaffected children. Nasal obstructive symptoms were more frequently reported in cleft lip with cleft palate compared with unaffected children (p < 0.0001); children who had isolated cleft lip with or without alveolus and isolated cleft palate were not statistically different from unaffected children. Patients with unilateral cleft lip with cleft palate were found to be more severely affected than bilateral cases. Nasal obstruction was observed in early childhood, although severity worsened in adolescence.
  
  
  CONCLUSIONS
  This population-based study reports a high prevalence of nasal obstructive symptoms in children with cleft lip and/or cleft palate based on type and severity of the cleft. The authors encourage cleft teams to consider using this or similar screening methods to identify which children may benefit from functional rhinoplasty.
  
  
  METHODS
  Risk, I.
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Sobol
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Allori
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Carlson
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Pien
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Watkins
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Aylsworth
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Meyer
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Pimenta
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Strauss
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Barry L
authors.initials: BL
authors.lastname: Ramsey
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Eileen
authors.initials: E
authors.lastname: Raynor
authors.affiliation: Durham, Chapel Hill, and Raleigh, N.C.|From Duke University School of Medicine; the Divisions of Plastic, Maxillofacial and Oral Surgery and Otolaryngology/Head and Neck Surgery and Communications Sciences, Duke Children's Hospital; the Departments of Dental Ecology, Genetics, and Pediatrics, and the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill; the State Center for Health Statistics, Department of Health and Human Services; and the Department of Physical Therapy, Methodist University.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002971:Cleft Lip / Q000150:complications* / Q000601:surgery; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D015995:Prevalence; D012225:Rhinoplasty; D012720:Severity of Illness Index