Nasal Airflow Dynamics Before and After Septorhinoplasty for Correction of Cleft Lip Nasal Deformity: A Single Patient Case Report
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Abstract
<jats:sec><jats:title>Background:</jats:title><jats:p> Unilateral cleft lip nasal deformity (uCLND) creates multiple sites of nasal airway obstruction, impacting patients’ quality of life. Surgical restoration of function remains technically challenging and complex. </jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p> This is a single patient case report to determine consistency of patient’s subjective perception of nasal outcomes after septorhinoplasty with objective assessments, and effectiveness of standard surgical techniques in targeting sites of greatest nasal anatomical obstruction. </jats:p></jats:sec><jats:sec><jats:title>Method:</jats:title><jats:p> Patient-reported quality of life (QOL) measures were collected. Pre- and post-surgery radiographic images of a patient with uCLND were obtained for computational fluid dynamics (CFD) modeling of patient-specific nasal function. Objective assessments were obtained using rhinomanometry and CFD. CFD-derived localized resistance at multiple cross-sectional segments were determined and used to identify greatest nasal obstructive sites. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Patient-reported QOL scores improved by 20 to 73 points. CFD-calculated bilateral resistance decreased from 0.155 to 0.061 Pa.s/ml, cleft-side resistance from 0.407 to 0.091 Pa.s/ml, and non-cleft-side from 0.228 to 0.120 Pa.s/ml. Rhinomanometry showed similar decreases in resistance. On the cleft side, 25 identified sites of greatest obstruction decreased to 15 sites post-surgery; on the non-cleft side, 23 sites of greatest obstruction decreased to 16 sites post-surgery. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Results suggest improvement in nasal patency after septorhinoplasty. Additional greatest obstructive sites in the post-surgical airway were mostly around the superior airway. </jats:p></jats:sec>
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Gosman, RE, JR Marcus and DO Frank-Ito (n.d.). Nasal Airflow Dynamics Before and After Septorhinoplasty for Correction of Cleft Lip Nasal Deformity: A Single Patient Case Report. FACE. pp. 273250162311774–273250162311774. 10.1177/27325016231177456 Retrieved from https://hdl.handle.net/10161/27539.
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Jeffrey Robert Marcus
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.
Dennis Onyeka Frank-Ito
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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