Three-Dimensional Computed Tomographic Analysis of the Maxilla in Unilateral Cleft Lip and Palate: Implications for Rhinoplasty

Background: The cleft lip nose is a complex 3-dimensional (3D) midfacial soft tissue and bony deformity. The contribution of maxillary hypoplasia to the etiology of this deformity has often been implicated for the suboptimal results of surgical treatment. The dimensions of the maxilla in unilateral cleft lip and palate (UCLP) have not been studied especially in relation to the volumetric and other asymmetries on the either side in unilateral clefts. The purpose of this article is to assess the relevant maxillary parameters of length, width, height, depth, and volume in patients with UCLP and compare the parameters of the cleft and noncleft sides. Methods: Fifteen patients with UCLP were treated by a standard protocol by a single surgeon and orthodontist. The measurements of maxilla were taken using a combination of axial, coronal, lateral, and 3D reconstructed images. The volume of each maxilla was calculated on 3D reconstructions using the technique of manual segmentation, which allowed complete reconstruction of the right and left maxilla individually. Results: In general, the cleft maxillary length, width, height, depth, and volume have been found to be reduced when compared with the normal sides with significant P values (Wilcoxon signed rank test Z, P < 0.001). Conclusions: The study demonstrates the anatomy of the maxillary asymmetry existing in UCLP and underlines the importance of correcting the bony deficiency by appropriate techniques to harmonize the results of rhinoplasty in unilateral cleft lip nose deformity. Augmentation of the deficient maxilla by specific contoured bone grafts allows restoration of the symmetry of the nasal platform in unilateral cleft lip nose deformity.