April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Reprinted by permission of Cleft Palate Craniofac J. 2019; 56(2):177-186.

Original Article

The Cleft Palate-Craniofacial Journal 2019, Vol. 56(2) 177-186 ª 2018, American Cleft Palate-

Nasal Obstruction in Children With Cleft Lip and Palate: Results of a Cross-Sectional Study Utilizing the NOSE Scale

Craniofacial Association Article reuse guidelines:

sagepub.com/journals-permissions DOI: 10.1177/1055665618772400 journals.sagepub.com/home/cpc

Rosaline S. Zhang, BA 1 , Lawrence O. Lin, BS 1 , Ian C. Hoppe, MD 1 , Oksana A. Jackson, MD 1 , David W. Low, MD 1 , Scott P. Bartlett, MD 1 , Jordan W. Swanson, MD 1 , and Jesse A. Taylor, MD 1

Abstract Objective: To characterize the epidemiology and risk factors for nasal obstruction among subjects with cleft lip and/or cleft palate (CL/P) utilizing the well-validated Nasal Obstruction Symptom Evaluation (NOSE) survey. Design: Retrospective cross-sectional study. Setting: Cleft Lip and Palate Program, Children’s Hospital of Philadelphia. Patients, Subjects: One thousand twenty-eight surveys obtained from 456 subjects (mean age: 10.10 (4.48) years) with CL/P

evaluated between January 2015 and August 2017 with at least 1 completed NOSE survey. Interventions: Nasal Obstruction Symptom Evaluation surveys completed at each annual visit. Main Outcome Measures: Composite NOSE and individual symptom scores.

Results: Sixty-seven percent of subjects had nasal obstruction at some point during the study period, with 49% reporting nasal obstruction at latest follow-up. subjects aged 14 years and older reported the most severe symptoms ( P ¼ .002). Subjects with cleft lip and alveolus (CL þ A) and unilateral cleft lip and palate (CLP) reported more severe nasal blockage than other phenotypes ( P ¼ .021). subjects with a history of either posterior pharyngeal flap (PPF) or sphincter pharyngoplasty (SP) had significantly higher NOSE scores than subjects with no history of speech surgery ( P ¼ .006). There was no significant difference ( P > .050) in NOSE scores with regard to history of primary tip rhinoplasty, nasal stent use, or nasoalveolar molding. Conclusions: There are more severe nasal obstructive symptoms among subjects older than 14 years of age, with CL þ A or unilateral CLP, and with a history of PPF or SP. Future studies utilizing the NOSE are needed to evaluate and address this prevalent morbidity in the CLP population.

Keywords cleft lip, cleft palate, nasal obstruction

(Grossmann et al., 2005) and have higher prevalence of nasal obstruction (Sobol et al., 2016) and mouth breathing symptoms (Mor´en et al., 2013).

Introduction Nasal deformity is a significant and complex sequela of cleft lip and/or cleft palate (CL/P). The severity of the deformity varies depending on the degree of the cleft anomaly (Sykes et al., 2016). Literature on cleft lip (CL) nasal deformity has primar- ily focused on treatment to improve the aesthetic appearance (Sobol et al., 2016). Until recently, few studies have addressed the functional consequences of the deformity, namely nasal obstruction due to nasal septal deviation, alterations of the external nasal valve, or turbinate hypertrophy (Wetmore, 1992). Compared to age-matched noncleft controls, cleft patients have lower airflow and ability to detect smells

1 Division of Plastic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Corresponding Author: Jesse A. Taylor, Department of Surgery, The Children’s Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA 19104, USA. Email: jataylor@gmail.com

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