Our Summary

This study focused on the nasalis muscle, which plays a significant role in the structure of the nose. Specifically, the researchers wanted to understand more about how this muscle affects the appearance of the nose in patients who have a cleft lip, a condition where the upper lip and roof of the mouth don’t form completely during pregnancy.

The researchers worked with 45 patients who had a unilateral complete pre-alveolar cleft, meaning one side of their upper lip and the gums right behind it hadn’t fully formed. They divided these patients into two main groups.

The first group only had a specific muscle in their face (the Orbicularis muscle) repaired. The second group was split into two subgroups. Both of these subgroups also had the Orbicularis muscle repaired, but one subgroup also had work done on the nasalis muscle (where it originates), while the other subgroup had work done on both the origin and insertion of the nasalis muscle.

The results of the study showed that patients in the subgroup where both the origin and insertion of the nasalis muscle were repaired had the best outcomes in terms of the shape and symmetry of their noses. This group’s post-surgery results were closest to the appearance of a typical, non-cleft side of a nose.

The researchers concluded that doing surgery on both the origin and insertion of the nasalis muscle can help cleft lip patients have a nose shape and size similar to those without this condition.

FAQs

  1. What is the role of the nasalis muscle in cleft lip repair?
  2. How did the patients’ results differ between those who only had the Orbicularis muscle repaired and those who also had the nasalis muscle repaired?
  3. What improvements were observed in patients who had both the origin and insertion of the nasalis muscle repaired?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about cleft lip repair is to consider undergoing dissection and repair of both the origin and insertion of the nasalis muscle during the surgical procedure. This can help improve the shape and symmetry of the nasal tip, size and symmetry of nostrils, and overall appearance of the nose, bringing it closer to the non-cleft side and the normal population.

Suitable For

Patients with unilateral complete pre-alveolar cleft lip deformity are typically recommended for cleft lip repair surgery. In particular, patients with abnormal anatomy of the nasalis muscle and alar deformity may benefit from repair of the nasalis muscle in addition to the orbicularis oris muscle during cleft lip repair surgery. Repair of both the origin and insertion of the nasalis muscle has been shown to improve nasal symmetry, nostril size and symmetry, nasal tip shape and projection, and overall facial aesthetics in cleft lip patients. This approach may result in outcomes that closely resemble those of non-cleft individuals of the same age.

Timeline

Before cleft lip repair:

  1. Diagnosis of cleft lip deformity during prenatal ultrasound or at birth
  2. Consultation with a multidisciplinary team including plastic surgeons, speech therapists, and orthodontists
  3. Preoperative assessment and preparation, including medical history review, physical examination, and imaging studies
  4. Education and counseling for the patient and family regarding the procedure and postoperative care

After cleft lip repair:

  1. Surgery to repair the cleft lip, typically performed when the child is around 3-6 months old
  2. Postoperative monitoring and management of pain, swelling, and potential complications
  3. Follow-up appointments with the surgical team for assessment of healing and cosmetic outcome
  4. Speech therapy and orthodontic treatment as needed to address any speech or dental issues related to the cleft lip
  5. Long-term monitoring for potential need for additional surgeries or interventions as the child grows

In conclusion, cleft lip repair involves a comprehensive and coordinated approach to address the physical, functional, and aesthetic aspects of the condition, with the goal of achieving optimal outcomes for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft lip repair include:

  1. What specific surgical techniques will be used to repair my cleft lip?
  2. How will the repair of the nasalis muscle affect the outcome of the surgery?
  3. What are the potential risks and complications associated with cleft lip repair, including the repair of the nasalis muscle?
  4. What is the expected recovery process after cleft lip repair surgery, and how long will it take to see the final results?
  5. Will additional follow-up procedures or treatments be necessary after the initial cleft lip repair surgery?
  6. How will the repair of the nasalis muscle impact the overall symmetry and appearance of my nose?
  7. Can you provide before and after photos of previous patients who have undergone cleft lip repair with nasalis muscle repair?
  8. How experienced are you in performing cleft lip repair surgeries, particularly those involving the repair of the nasalis muscle?
  9. What type of anesthesia will be used during the cleft lip repair surgery, and what are the associated risks?
  10. How should I prepare for the cleft lip repair surgery, both physically and mentally?

Reference

Authors: Attia SA, Helal HA, El Barabary AS, Awad MA, Sherif MM. Journal: J Craniomaxillofac Surg. 2019 Feb;47(2):255-262. doi: 10.1016/j.jcms.2018.11.030. Epub 2018 Dec 5. PMID: 30591393