Nasal Septal Anatomy In Skeletally Mature Patients With Cleft Lip/palate
Christopher M. Runyan, MD, PhD, Jonathan P. Massie, BS, Marleigh J. Stern, BA, Michael Alperovich, MD, David A. Staffenberg, MD, Roberto L. Flores, MD.
New York University, New York, NY, USA.
Septal deviation commonly occurs in patients with cleft lip and palate (CL/P), however the contribution of the cartilaginous and bony septum to airway obstruction in skeletally mature patients, is poorly understood.
This study compares facial conebeam CT’s of skeletally mature CL/P-patients with age-matched controls. Septal deviation was measured in three coronal sections: the cartilaginous septum [anterior nasal spine (ANS)], bony septum [posterior nasal spine (PNS)] and midpoint between the ANS and PNS (MID). Stenosis was defined as the smallest distance between nasal septum and lateral nasal wall. Perpendicular plate of the ethmoid (PPE) and vomer displacement were measured as angles from vertical at the coronal slice of maximal septal deviation. Comparisons between groups were made using Student’s t-test. Stepwise multivariable linear regression was used to compare septal deviation to stenosis. Statistical significance was held at p<0.05.
24 CL/P-patients and 16 age-matched controls were identified for the study. As shown in the figure, septal deviation (a) and stenosis (b) were significantly increased at all three sections in CL/P-patients compared to controls. The vomer, but not PPE, was significantly displaced from vertical (c). The severity of vomerine deviation (d) predicted the obstruction at the ANS.
Skeletally mature CL/P-patients have significant septal deviation involving both cartilage and bone. Resection of the bony and cartilaginous septum should be considered at time of definitive cleft rhinoplasty.
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