Unilateral Cleft Lip Nasal Deformity: Three-Dimensional Analysis of the Primary Deformity and Longitudinal Changes following Primary Correction of the Nasal Foundation

Plast Reconstr Surg. 2020 Jan;145(1):185-199. doi: 10.1097/PRS.0000000000006389.


Background: Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care.

Methods: Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes.

Results: Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type.

Conclusions: Unilateral cleft lip nasal deformity may be "driven" by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.

MeSH terms

  • Alveolar Bone Grafting / methods
  • Anatomic Landmarks / diagnostic imaging
  • Case-Control Studies
  • Child, Preschool
  • Cleft Lip / complications
  • Cleft Lip / diagnostic imaging
  • Cleft Lip / surgery*
  • Cleft Palate / diagnostic imaging
  • Cleft Palate / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional*
  • Infant
  • Longitudinal Studies
  • Male
  • Nose / abnormalities
  • Nose / diagnostic imaging*
  • Nose / surgery
  • Postoperative Period
  • Preoperative Period
  • Rhinoplasty / methods*
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome