Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency.
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Background:Nasal airway obstruction (NAO) due to nasal anatomic deformities is known to be more common among cleft patients than the general population, yet information is lacking regarding severity and variability of cleft-associated nasal obstruction relative to other conditions causing NAO. This preliminary study compares differences in NAO experienced by unilateral cleft lip nasal deformity (uCLND) subjects with noncleft subjects experiencing NAO. Methods:Computational modeling techniques based on patient-specific computed tomography images were used to quantify the nasal airway anatomy and airflow dynamics in 21 subjects: 5 healthy normal subjects; 8 noncleft NAO subjects; and 8 uCLND subjects. Outcomes reported include Nasal Obstruction Symptom Evaluation (NOSE) scores, cross-sectional area, and nasal resistance. Results:uCLND subjects had significantly larger cross-sectional area differences between the left and right nasal cavities at multiple cross sections compared with normal and NAO subjects. Median and interquartile range (IQR) NOSE scores between NAO and uCLND were 75 (IQR = 22.5) and 67.5 (IQR = 30), respectively. Airflow partition difference between both cavities were: median = 9.4%, IQR = 10.9% (normal); median = 31.9%, IQR = 25.0% (NAO); and median = 29.9%, IQR = 44.1% (uCLND). Median nasal resistance difference between left and right nasal cavities were 0.01 pa.s/ml (IQR = 0.03 pa.s/ml) for normal, 0.09 pa.s/ml (IQR = 0.16 pa.s/ml) for NAO and 0.08 pa.s/ml (IQR = 0.25 pa.s/ml) for uCLND subjects. Conclusions:uCLND subjects demonstrated significant asymmetry between both sides of the nasal cavity. Furthermore, there exists substantial disproportionality in flow partition difference and resistance difference between cleft and noncleft sides among uCLND subjects, suggesting that both sides may be dysfunctional.
Published Version (Please cite this version)10.1097/GOX.0000000000002244
Publication InfoMarcus, Jeffrey; Frank-Ito, Dennis O; Carpenter, David J; Cheng, Tracy; Avashia, Yash J; Brown, David A; ... Marcus, Jeffrey R (2019). Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency. Plastic and reconstructive surgery. Global open, 7(5). pp. e2244. 10.1097/GOX.0000000000002244. Retrieved from https://hdl.handle.net/10161/19250.
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Professor of Surgery
My research parallels our specialized clinical programs at Duke. I am involved in clinical research looking comprehensively at outcomes of cleft care to develop standards for evaluating a team’s overall success. Based on a recent grant from the Centers for Disease Control (CDC), we are also participating with several centers to look specifically at academic, psychosocial, and surgical outcomes for all children with clefts born in North Carolina. We are committed to the technique of