Nasal symmetry: a 10-year comparison between the Pigott and McComb nasal correction

doi:10.1016/0007-1226(91)90088-2

British Journal of Plastic Surgery

Volume 44, Issue 8, 1991, Pages 562-566

https://doi.org/10.1016/0007-1226(91)90088-2 Get rights and content

Abstract

The objective assessment of the symmetry of the cleft lip nose has not been properly evaluated. A simple technique using enlarged photographs and area assessment is described. Two different techniques were assessed, the Pigott “alar leapfrog” technique and the McComb alar lift technique. The children were assessed at 10 years of age. The results show no differences in the linear measurements or when the symmetry is assessed in the frontal view. In the worm's eye view, the Pigott correction was shown to produce a more asymmetric nose when compared with the McComb technique. Both corrections produce significant asymmetry when compared with a control group.

Reference (11)

PigottR.W.
“Alar leapfrog.” A technique for repositioning the total alar cartilage at the primary cleft lip repair
Clinics in Plastic Surgery
(1985)
RabeyG.P.
Current principles of morphanalysis and their implications in oral surgical practice
British Journal of Oral Surgery
(1977)
SaxbyP.J. et al.
The use of an independent panel to assess the long term results of cleft lip repair
British Journal of Plastic Surgery
(1986)
BlairV.P. et al.
The Mirault Operation for single hairlip
Surgery, Obstetrics and Gynaecology
(1930)
CoughlanB. et al.
A computer based technique for reassessment of asymmetry in the repaired cleftlip and nose
British Journal of Plastic Surgery
(1987)

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Cited by (19)

Nasal asymmetry in unilateral cleft lip and palate
2013, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Previous studies which have objectively measured nasal asymmetry were largely restricted to complicated and/or time consuming methods. These include manual tracing of facial photographs and cephalometric analysis.20,21 Computer-aided techniques have been shown to have a high degree of reproducibility, suggesting they may be useful for routine evaluation.23
Comparison of nasal asymmetry between unilateral cleft lip and palate (UCLP) patients with and without nasal correction at primary repair. Assessment of the value of Symnose as a routine research tool.
75 ten-year-old UCLP patients who underwent primary lip repair by one of two techniques: classical Millard with primary nasal correction (n = 30) or modified Millard without nasal correction (n = 45). Control group of ten-year-old school children (n = 45).
Nasal asymmetry of participants was measured from facial photographs taken in two views: frontal and basal. The Symnose computer program was used to calculate asymmetry for three parameters: front perimeter (FP), base perimeter (BP) and nostrils (N). Total asymmetry was also calculated. Each image was traced on three separate occasions and a mean of the three measurements was calculated.
BP, N and total asymmetry were significantly greater in UCLP patients without nasal correction compared to both controls and patients with correction (BP = 12.73% v 4.90% v 6.75%, N = 47.73% v 15.83% v 30.75%, total = 81.87% v 46.43% v 54.68%, p ≤ 0.001). FP asymmetry was significantly greater in controls than all UCLP patients (22.87% v. 18.18% and 15.07%, p = 0.001 and p = 0.008). BP measurements have a higher degree of repeatability than FP and N (Coefficient of repeatability = 5.99, 17.02 and 16.47, respectively).
Primary nasal correction produces greater nasal symmetry during childhood from the basal view. Symnose is a simple method of objectively measuring asymmetry in UCLP, however improvements are required before it can be considered a useful research tool.
Bilateral cleft lip and nose repair
2011, British Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Primary surgical reshaping of the alar cartilages in BCLP has been advocated by a number of surgeons.5,30–33 Access to the alar cartilages was initially achieved by external approaches through the flattened nasal tip, but dissatisfaction with long-term results led to more conservative approaches through intranasal incisions that resulted in less visible scarring.6,29,31,34–36 The reshaped lower alar cartilages can be supported by direct suturing or long-term nasal splints (Fig. 5).
Over the last three decades bilateral cleft lip and nose repair has been characterised by a trend towards more detailed reconstruction of the nasolabial muscles together with simultaneous correction of the deformity. An understanding of the true nature of the nasal deformity in bilateral cleft lip and palate (BCLP) has gradually emerged, and has inspired new approaches to their repair. This article discusses recent trends and controversies in primary cheilorhinoplasty for BCLP.
A 20 year audit of nose-tip symmetry in patients with unilateral cleft lip and palate
2001, British Journal of Plastic Surgery
The purpose of this study was to audit the process and outcome in terms of nasal-tip symmetry of the first 20 patients with unilateral complete cleft lip and palate treated by the Pigott alar leapfrog primary nasal correction in the early 1970s and followed for 20 years. Symmetry was assessed using the Coghlan computer-based analysis of frontal and basal views to determine the stability of the correction. The Åbyholm technique of alveolar bone grafting was performed in 12 of the 20 patients. Various other secondary procedures have been performed on the nose tip and septum to improve the airway or appearance. Photographs were taken within one year of ages 5, 10, 15 and 20 years, and the lower border of the nose, the alar domes and the nostrils were assessed. To assess the overall change from5 years to 20 years, both views were available for 17 patients. No significant change was found in the lower border or nostril symmetry, but significant deterioration at the P< 0.01 level was found on the basal view. We assessed the 10, 15 and 20 year views of all 12 patients who had undergone alveolar bone grafting to determine early and late changes. No significant benefit was found from alveolar bone grafting or minor secondary procedures for appearance. Consequently, our criteria for undertaking minor adjustments to improve appearance have become more stringent. We consider that objective reporting of appearance should become essential in peer-reviewed journals.
Sir Harold Gillies memorial lecture: Speak comfortably
2000, British Journal of Plastic Surgery
Outcome analysis of a modified Tajima procedure
1997, British Journal of Plastic Surgery
Secondary nasal correction of cleft patients is acknowledged to be a difficult problem. There are many different operations but few objective assessments of their results. We have evaluated the results of a modified Tajima operation by use of the Bristol computer technique. Eighteen patients were followed up for a mean of 33 months (range 10–56). Measures of asymmetry were obtained for different photographic views, preoperatively and at later postoperative visits.
In all views there was a significant improvement in shape in the early postoperative photos. This same improvement was also seen when comparing preoperative to late postoperative results i.e. this initial improvement is maintained over time. There was no significant difference between the early and late postoperative views.
In this small series the modified Tajima technique has given statistically significant lasting improvement. However, few other operations have been objectively assessed and hence comparison is difficult. We advocate the use of the computer technique for other procedures to allow meaningful comparisons between them.
A panel based assessment of early versus no nasal correction of the cleft lip nose
1993, British Journal of Plastic Surgery
There is a need to be able to assess the overall result in a significant series of cases of a method of management of the cleft lip and nose deformity in order to avoid “best case” reporting often used to introduce new techniques. The present study was performed by a panel placing standardised base view photographs in rank order. The photographs were of 10-year-old subjects of whom 15 were normal controls, 22 were from the Rikshospitalet, Oslo, all of whom had no primary nasal correction and 25 from Frenchay Hospital, Bristol, who all had radical primary nasal correction.
Ranking was performed for upper nasal perimeter symmetry, nostril outline symmetry and for overall aesthetic appearance. Analysis of the results showed a significant difference between the three groups, with the corrected noses showing better symmetry. Inter and intraobserver correlations were very close.
The limitations of a ranking and marking method of panel assessment are discussed, and a computerised method is presented in subsequent papers.

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Nasal symmetry: a 10-year comparison between the Pigott and McComb nasal correction

Abstract

Clinics in Plastic Surgery

British Journal of Oral Surgery

British Journal of Plastic Surgery

The Mirault Operation for single hairlip

Surgery, Obstetrics and Gynaecology

A computer based technique for reassessment of asymmetry in the repaired cleftlip and nose

British Journal of Plastic Surgery