Nasolabial Esthetics in Children With Complete Unilateral Cleft Lip and Palate After 1- Versus 3-Stage Treatment Protocols

Fudalej, Piotr; Katsaros, Christos; Bongaarts, Catharina; Dudkiewicz, Zofia; Kuijpers-Jagtman, Anne Marie

doi:10.1016/j.joms.2009.04.003

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 8 , Pages 1661-1666, August 2009

Nasolabial Esthetics in Children With Complete Unilateral Cleft Lip and Palate After 1- Versus 3-Stage Treatment Protocols

Piotr Fudalej, DDS, MSD, PhD
- Assistant Professor, Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
- Address correspondence and reprint requests to Dr Fudalej: Department of Pediatric Surgery, Institute of Mother and Child, Kasprzaka Street 17a, 01-211 Warszawa, Poland
Christos Katsaros, DDS, DrMedDent, DrOdont, PhD
- Professor and Head, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
Catharina Bongaarts, DDS, PhD
- Assistant Professor, Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Zofia Dudkiewicz, MD, MS, PhD
- Professor and Head, Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
Anne Marie Kuijpers-Jagtman, DDS, PhD, FDSRCSEng
- Professor and Head, Department of Orthodontics and Biology, and Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Purpose

Facial esthetics play an important role in social interactions. However, children with a repaired complete unilateral cleft lip and palate usually show some disfigurement of the nasolabial area. To date, few studies have assessed the nasolabial appearance after different treatment protocols. The aim of the present study was to compare the nasolabial esthetics after 1- and 3-stage treatment protocols.

Materials and Methods

Four components of the nasolabial appearance (nasal form, nasal deviation, mucocutaneous junction, and profile view) were assessed by 4 raters in 108 consecutively treated children who had undergone either 1-stage closure (Warsaw group, 41 boys and 19 girls, mean age 10.8 years, SD 2.0) or 3-stage (Nijmegen group, 30 boys and 18 girls, mean age 8.9 years, SD 0.7). A 5-grade esthetic index of Asher-McDade was used, in which grade 1 indicates the most esthetic and grade 5 the least esthetic outcome.

Results

The nasal form was judged the least esthetic in both groups and graded 3.1 (SD 1.1) and 3.2 (SD 1.1). The nasal deviation, mucocutaneous junction, and profile view were scored from 2.1 (SD 0.8) to 2.3 (SD 1.0) in both groups. The treatment outcome after the Warsaw and Nijmegen protocols was comparable. Neither overall nor any of the 4 components of the nasolabial appearance showed intercenter differences (P > .1).

Conclusions

The nasolabial appearance after the Warsaw (1-stage) and Nijmegen (3-stage) protocols was comparable. The technique of lip repair (triangular flap in Warsaw and Millard rotation advancement in Nijmegen) gave comparable results for the esthetics of the nasolabial area.