PHOTOGRAMMETRIC COMPARISON OF 2 METHODS FOR SYNCHRONOUS REPAIR OF BILATERAL CLEFT-LIP AND NASAL DEFORMITY

The principle of synchronous repair of bilateral complete cleft lip an d nasal deformity is established, and the techniques are evolving. We undertook photogrammetric comparison of the method described by Mullik en (group I, n = 15) and that described by Trott (group II, n = 10). F acial proportions and angles were measured on preoperative and postope rative photographs using defined anthropometric points. The following criteria were quantified for each test group: nasolabial angle, nasal tip angle and projection, nasal width, columellar length and width, an d philtral width. All parameters in both groups were compared against each other and against normal age-matched values. Results were analyze d by t test. The nasolabial angle, nasal tip angle, and nasal width we re abnormally wide for both techniques (p < 0.01 for both), and there was no difference between them. Nasal tip projection was greater than normal in both techniques (p < 0.01); group I had significantly greate r projection than group II (p = 0.02). Columellar length as a proporti on of nasal tip protrusion approached normal in group I but was signif icantly shorter than normal in group II (p < 0.001). Columellar width, as a proportion of nasal width, was normal for both groups. Philtral width, in proportion to nasal width, was normal in group I and abnorma lly high in group II (p < 0.001). This difference was significant betw een the two groups (p < 0.001). In a separate cohort of 10 group I pat ients, the nasolabial angle was measured on lateral photographs taken 1 year post-repair and at intervals to late childhood and adolescence. Nasolabial angle changed with age from obtuse to normal in 7 of 10 pa tients followed to 9 years of age and in 5 of 6 patients followed unti l age 15 years. Columellar and upper labial inclination to the vertica l were measured in 7 of these patients at 3 to 4 years and again at 13 to 15 years. There was an increase in inclination of both columella a nd the upper lip, between the ages of 3 to 4 and 13 to 15 years, refle cting improved lip support and growth of septum and lateral cartilages .