Facial Symmetry in Unilateral Cleft Lip and Palate following Alar Base Augmentation with Bone Graft: A Three-Dimensional Assessment

Abstract

Objective: The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry. Design: This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry. Patients: This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented. Results: Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p = 0.005). Conclusions: 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.