Characterizing Olfactory Dysfunction in Patients with Unilateral Cleft Lip Nasal Deformities.


Background: Unilateral cleft lip nasal deformity (uCLND) is associated with olfactory dysfunction, but the underlying etiology remains poorly understood. Objective: To investigate the etiology of uCLND-associated olfactory dysfunction using clinical, computational, and histologic assessments. Methods: Inclusion criteria: uCLND patients >16 years undergoing septorhinoplasty. Exclusion criteria: prior septoplasty or rhinoplasty, pregnancy, sinusitis. Measured outcomes: patient-reported scores, rhinomanometry, smell identification and threshold tests, computational fluid dynamics (CFD) airflow simulations, and histologic analysis of olfactory epithelium. Results: Five uCLND subjects were included: 18-23 years, three male and two female, four left-sided cleft and one right-sided cleft. All subjects reported moderate to severe nasal obstruction. Smell identification and threshold tests showed varying degrees of hyposmia. Nasal resistance was higher on the cleft side versus noncleft side measured by rhinomanometry (median 3.85 Pa-s/mL, interquartile range [IQR] = 21.96, versus 0.90 Pa-s/mL, IQR = 5.17) and CFD (median 1.04 Pa-s/mL, IQR = 0.94 vs. 0.11 Pa-s/mL, IQR = 0.12). Unilateral olfaction varied widely and was dependent on unilateral percentage olfactory airflow. Biopsies revealed intact olfactory neuroepithelium. Conclusions: uCLND-associated olfactory dysfunction appears to be primarily conductive in etiology and highly susceptible to variations in nasal anatomy. Clinical Trial Registration number: NCT04150783.






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Publication Info

Russel, Sarah M, Harry Chiang, John B Finlay, Reanna Shah, Jeffrey R Marcus, David W Jang, Ralph Abi Hachem, Bradley J Goldstein, et al. (2023). Characterizing Olfactory Dysfunction in Patients with Unilateral Cleft Lip Nasal Deformities. Facial plastic surgery & aesthetic medicine. 10.1089/fpsam.2022.0367 Retrieved from

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Harry Chiang

House Staff

Jeffrey Robert Marcus

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 nasoalveolar molding for children with clefts and are engaged in analyzing its benefits. In rhinoplasty, we have developed a model for nasal respiratory physiology, and we are looking at the effects of specific surgical procedures on nasal airflow and resistance. Our Craniofacial imaging lab has developed sophisticated software to analyze cranial shape, and we use these techniques to define abnormal conditions and their treatment relative to normal. Lastly, our craniomaxillofacial trauma team continues to look at factors associated with facial trauma in North Carolina in order to implement techniques and processes to deliver optimal care and results.


David W Jang

Associate Professor of Head and Neck Surgery & Communication Sciences

My clinical expertise is in diseases of the nose, sinuses, and skull base.  I perform endoscopic sinus surgery, nasal airway surgery, and minimally invasive endonasal surgery of the pituitary and skull base. 

Abi Hachem

Ralph Abi Hachem

Associate Professor of Head and Neck Surgery & Communication Sciences

Dennis Onyeka Frank-Ito

Associate Professor in Head and Neck Surgery & Communication Sciences

My research interests include modeling the effects of human airway anatomy on respiratory airflow patterns, deposition of inhaled gases and particle transport using computational fluid dynamics.

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