What happens to columellar angle after cleft lip surgery?
O que ocorre com o ângulo columelar após cirurgia de correção da fissura labial?
Mario Jorge Frassy Feijo; Stella Ramos Brandao; Rui Manoel Rodrigues Pereira; Mariana Batista de Souza Santos; Hilton Justino da Silva
Abstract
Purpose: to evaluate post operative columelar angle changes after cleft lip repair.
Methods: observational, descriptive and cross-sectional study. Were evaluated 11 childrens in first and second year old, with unilateral cleft lip, of both genres, who underwent surgery to correct the lip defect. Were examined child's nasal area and upper lip and identified anthropometric points pronsale, subnasale and glabella, then photographic documentation was performed for photogrammetric analysis. Photos were taken preoperatively and 4 months after surgery. Images obtained by photogrammetry were evaluated with graphics program Image J, through angular study tools.
Results: the mean of angles measured preoperatively was 55.41 degrees, and at the postoperative was 78.80 degrees, realizing an approximation to the vertical plane (p< 0.0001). Cleft lip and palate patients had a variation of 32 degrees when compared pre and post-operative measurements, while in patients with only cleft lip or cleft lip and alveolus the changes where minors (0.75 and 25 degrees respectively).
Conclusion: occurs a columellar angle verticalization after cleft lip surgery. Patients that had greater increase to the angle were those who had more complex deformities.
Keywords
Resumo
Objetivo: avaliar a mudança do ângulo columelar que ocorre após cirurgia de correção para fissura labial.
Métodos: o estudo foi observacional de caráter descritivo e de corte transversal. Foram avaliadas crianças no primeiro e segundo ano de vida, portadoras de fissura labial unilateral de ambos os sexos, que foram submetidas a cirurgia para correção da fissura. A pesquisa teve um total de 11 crianças participantes. Foi examinada a região nasal e lábio superior da criança e identificados os pontos antropométricos pronsal, subnasal e glabela. Em seguida, foi realizada fotografia para análise fotogramétrica. Foram realizadas fotos no preoperatório e cerca de 4 meses após a cirurgia. As imagens obtidas por fotogrametria foram avaliadas com o programa gráfico Image J, por meio de ferramentas de estudo angular.
Resultados: a média da medida dos ângulos no pré-operatório foi de 55,41 graus; a média no pós foi de 78,80 graus, percebendo-se uma aproximação ao plano vertical (p<0,0001). Pacientes com fissura lábio-palatina apresentaram variação de 32 graus quando comparadas as medidas pré e pós-operatórias, enquanto que nos pacientes com fissura pré-foramen incompleta e pré-foramen completa foram menores (0,75 e 25 graus respectivamente).
Conclusão: ocorre verticalização do ângulo columelar após cirurgia de correção da fissura labial. Os pacientes que apresentam maior modificação do ângulo são, justamente, aquelas que apresentam diagnóstico relacionado a deformidades mais complexas.
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Referencias
1. Paranaiba LM, Miranda RT, Martelli DR, Bonan PR, Almeida Hd, Orsi Júnior JM et al. Cleft lip and palate: series of unusual clinical cases. BrazJ Otorhinolaryngol. 2010;76(5):649-53.
2. Mossey PA, Modell B. Epidemiology of oral clefts 2012: an international perspective. Front Oral Biol. 2012;16:1-18.
3. Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: synthesizing genetic and environmental influences. Nat Rev Genet. 2011;12(3):167-78.
4. Spina V, Psillakis JM, Lapa FS, Ferreira MC. Classificação das fissuras lábio-palatinas. Rev Hosp Clin Fac Med S Paulo. 1972;27(2):5-6.
5. McCorkell G, McCarron C, Blair S, Coates V. Parental experiences of cleft lip and palate services. Community Pract. 2012;85(8):24-7.
6. Fisher DM, Tse R, Marcus JR. Objective Measurements for Grading the Primary Unilateral Cleft Lip Nasal Deformity. Plast Reconstr Surg. 2008;122:874-80.
7. Fisher DM, Sommerlad BC. Cleft lip, cleft palate, and velopharyngeal insufficiency. Plast Reconstr Surg. 2011;128(4):342e-60e.
8. Hood CA, Hosey MT, Bock M, White J, Ray A, Ayoub AF. Facial characterization of infants with cleft lip and palate using a three- dimensional capture technique. Cleft Palate Craniofac J. 2004;41(1):27-35.
9. Yeow VKL, Huang MHS, Lee ST, Fook Chong SMC. An anthropometric analysis of indices of severity in unilateral cleft lip.The Journal of Craniofacial Surgery.2002;13(1):68-74.
10. Liou EJW, Subramanian M, Chen PKT, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg. 2004;114(4):858-64.
11. Amaral CER. Avaliacao do percentual de assimetria labial e nasal em pacientes com fissura labio-palatina submetidos a queiloplastia primaria. Rev. Bras. Cir. Plast. 2010;25(1):38-48.
12. Guyuron B. MOC-PS(SM) CME article: late cleft lip nasal deformity. Plast Reconstr Surg. 2008;121(4 Suppl):1-11.
13. Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgicalnasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2005;42(6):658-63.
14. Doddi NM, Eccles R. The role of anthropometric measurements in nasal surgery and research: a systematic review. Clin Otolaryngol. 2010;35(4):277-83.
15. Masuoka H, Kawai K, Morimoto N, Yamawaki S, Suzuki S. Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities. J Plast Reconstr Aesthet Surg. 2012;65(7):857-63.
16. Hammond P .The use of 3D face shape modeling in dysmorphology.Arch Dis Child. 2007;92(12):1120-6.
17. He Z, Jian X, Wu X, Gao X. Anthropometric measurement and analysis of the external nasal soft tissue in 119 young hancinese adults. J Craniofac Surg. 2009;20:1347-51.
18. Liceras Liceras E, Marton Cano F, Diaz Moreno E, Garcia Gomez M, Espana Lopez A, Munoz Miguelesanz MA et al. Presurgicalnasoalveolar molding a child with cleft lip and palate. Cir Pediatr. 2012;25(2):109-12.
19. Farkas LG. Anthropometry of the Head and Face. 2nd ed. New York, NY: Raven Press 1994.
20. Demke JC, Tatum SA. Analysis and evolution of rotation principles in unilateral cleft lip repair. J Plast Reconstr Aesthet Surg. 2011;64(3):313-8.
21. Li GH, Feng XH, Wu GF, Wei JH, Li XD. Three-dimensional analysis of facial structure for unilateral cleft lip patients repaired by Millard's method.ZhonghuaZheng Xing WaiKeZaZhi. 2010;26(2):99-102.
22. Adenwalla HS, Narayanan PV. Primary unilateral cleft lip repair. Indian J Plast Surg. 2009;42:62-70.
23. Nakamura N, Okawachi T, Nishihara K, Hirahara N, Nozoe E. Surgical technique for secondary correction of unilateral cleft lip-nose deformity: clinical and 3-dimensional observations of preoperative and postoperative nasal forms. J Oral Maxillofac Surg. 2010;68(9):2248-57.
24. Tanikawa DY, Alonso N, Rocha DL. Evaluation of primary cleft nose repair: severity of the cleft versus final position of the nose. J Craniofac Surg. 2010;21(5):1519-24.
25. Barillas I, Dec W, Warren SM, Cutting CB, Grayson BH. Nasoalveolarmolding improves long-term nasal symmetry in complete unilateral cleft lip- cleft palate patients. Plast Reconstr Surg. 2009;123:1002-6.
26. Abbott MM, Meara JG. Nasoalveolar molding in cleft care: is it efficacious? Plast Reconstr Surg. 2012;130(3):659-66.
27. Farkas LG, Bryson W, Klots J. Is photogrammetry of the face reliable? Plast Reconstr Surg 1980;66:346-55.
Submitted date:
19/02/2013
Accepted date:
24/07/2013
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