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An anatomical composite nasal lining subunit technique in primary cleft nose correction.

ABSTRACT: Current primary cleft nose correction techniques are associated with a significant rate of long term alar collapse. The nasal lining on the cleft side has been observed to be distorted and deficient. Nasal endoscopy was used to map the two dimensional topography of the anterior nasal airway lining in a normal and patient with unilateral cleft lip. The vestibular nasal subunit was noted to have a triple structural overlap (Lateral crus, valve and vestibule units). A nasal lining subunit based surgical strategy was designed, based on the subunit principle. The lateral crural tethering was released and differential repositioning of the cartilage/lining complex performed. The difference in domal height between the cleft and non-cleft sides was translated into a superior and medial advancement of the cartilage/lining composite subunit. The valve sub-unit defect was resurfaced with a vermilion full thickness graft, taken at the time of primary cleft lip repair. Primary septal relocation was performed and no percutaneous cartilage sutures were done. Pre and post-operative anthropometry measurements were obtained, and repeated at follow up. Complete nasal correction was seen in the unilateral cleft lip patient and was noted to be stable at 1 year follow-up. A novel nasal cartilage/lining subunit topographical map is proposed and forms the basis for a surgical strategy addressing comprehensive correction of the unilateral cleft nasal deformity.

SUBMITTER: Mendonca DA

PROVIDER: S-EPMC8027686 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Objective: Facial cleft involves complex malformations. No study assessed the facial deformity of Tessier No. 0 cleft with a bifid nose. Thus, we used anthropometric measurements to access the nose in patients. Methods: A total of 24 bifid nose deformities underwent surgery at our institution between 2010 and 2019. Standardized photographs were taken preoperatively and postoperatively. Landmarks were identified on these images; measurements for nasal analysis were performed and compared with the established Chinese norms. Surgical method differences were also analyzed. Results: The median follow-up time was 2.51 years. Postoperatively, there is a significant difference in comparison with preoperative in the nasal index, medial canthus and nose width index, nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. Furthermore, the medial canthus and nose width index, and nasal width and ala length index were significantly larger in ordinary people, while ala length and nasal bridge length index and nasal tip protrusion and nasal width index were smaller. After surgery, most angles and index were standard except the nasolabial angle in the females, and ala length and nasal bridge length index in the males. Moreover, as for the group of costal cartilage transplantation, most index and angles have improved after surgery including nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. However, only nasal tip protrusion and nasal width index, columella length and nasal tip protrusion index, and nasal width and ala length index in the silicone prosthesis group implantation has significance. Costal cartilage transplantation can also better improve ala length and nasal bridge length index than the silicone prosthesis implantation. Conclusion: Most defects can be repaired with surgery, but the outcome has a lack of evaluation. Thus, anthropometric assessment can serve as a material for nasal and reconstructive surgery.

Project description:BackgroundThe nasal mucosa, as a primary site of entry for inhaled substances, contains both inhaled xenobiotic and endogenous biomarkers. Nasal mucosa can be non-invasively sampled (nasal epithelial lining fluid "NELF") and analyzed for biological mediators. However, methods for untargeted analysis of compounds inhaled and/or retained in the nasal mucosa are needed.ObjectivesThis study aimed to develop a high resolution LC-MS untargeted method to analyze collected NELF. Profiling of compounds in NELF samples will also provide baseline data for future comparative studies to reference.MethodsExtracted NELF analytes were injected to LC-ESI-MS. After spectrum processing, an in-house library provided annotations with high confidence, while more tentative annotation proposals were obtained via ChemSpider database matching.ResultsThe established method successfully detected unique molecular signatures within NELF. Baseline profiling of 27 samples detected 2002 unknown molecules, with 77 and 463 proposed structures by our in-house library and Chemspider matching. High confidence annotations revealed common metabolites and tentative annotations implied various environmental exposure biomarkers are also present in NELF.SignificanceThe experimental pipeline for analyzing NELF samples serves as simple and robust method applicable for future studies to characterize identities/effects of inhaled substances and metabolites retained in the nasal mucosa.Impact statementThe nasal mucosa contains exogenous and endogenous compounds. The development of an untargeted analysis is necessary to characterize the nasal exposome by deciphering the identity and influence of inhaled compounds on nasal mucosal biology. This study established a high resolution LC-MS based untargeted analysis of non-invasively collected nasal epithelial lining fluid. Baseline profiling of the nasal mucosa (n = 27) suggests the presence of environmental pollutants, along with detection of endogenous metabolites. Our results show high potential for the analytical pipeline to facilitate future respiratory health studies involving inhaled pollutants or pharmaceutical compounds and their effects on respiratory biology.

Project description:Patients who undergo corrective surgery for cleft lip are known to be at risk for subsequently developing secondary nasal deformity. The aim of this study was to investigate the effects of Y-shaped conchal cartilage transplantation on the correction of nasal deformity secondary to cleft lip and its influence on mental health. Sixteen patients with nasal deformity secondary to cleft lip admitted to The First People's Hospital Xuzhou (Xuzhou, China) from February 2014 to February 2015 were selected for the study. Conchal cartilage was taken from the patients and made into a Y-shaped stent, which was then transplanted into the nasal columella. The surgical outcomes and patient satisfaction were evaluated and HADS was used to compare the preoperative and postoperative mental health. After the affected side of the nose was corrected, the nasal profiles of 12 patients were significantly improved, the height of nasal columella and nostril was significantly increased, the nasal base and breadth were significantly shorter than those before operation and the nose wing-nasal breadth index on the affected side was significantly increased compared to that before operation and the differences were statistically significant (P<0.05). The satisfaction of each index after the operation was more than 90%. The mental health of patients after operation was notably improved compared to before operation and the difference was statistically significant (P<0.05). After the correction of secondary nasal deformity to cleft lip through Y-shaped conchal cartilage transplantation, the shape of the nasal tip was stable without the recurrence of deformities or distortion on the donor site of the auricle. Y-shaped conchal cartilage transplantation is an ideal treatment method for the moderate and severe secondary nasal deformity to cleft lip and effective perioperative mental intervention can improve the patient's mental health status, an outcome that is worth popularizing in clinical applications.

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An anatomical composite nasal lining subunit technique in primary cleft nose correction.

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