April 2020 HSC Section 4 - Plastic and Reconstructive Problems

The Cleft Palate-Craniofacial Journal 56(2)

Table 3. Results According to Phenotype.

Most Severe NOSE Score, mean (SD)

Age Surveyed Composite Congestion Blockage Nose Breathing

Sleeping

Exercise

All phenotypes (n ¼ 456) Classification (n) Submucosal cleft (34)

9.50 (4.61)

3.95 (4.05)

1.36 (1.11)

0.74 (1.09)

0.86 (1.13)

0.51 (0.94) 0.47 (4.05)

8.07 (4.71) 6.67 (3.16) 9.70 (5.11) 9.36 (5.11) 11.41 (4.24) 7.78 (3.00)

3.88 (3.77) 2.84 (3.01) 4.03 (4.40) 4.28 (4.09) 3.65 (4.05) 4.22 (3.93)

1.50 (1.11) 1.27 (1.02) 1.29 (1.03) 1.49 (1.15) 1.21 (1.16) 1.22 (1.09)

0.53 (0.83) 0.30 (0.74) 0.76 (1.11) 0.89 (1.18) 0.62 (1.01) 1.11 (1.17)

0.79 (0.98) 0.65 (0.98) 0.83 (1.16) 0.95 (1.18) 0.86 (1.12) 0.77 (0.97)

0.65 (1.07) 0.41 (0.89) 0.40 (0.93) 0.22 (0.63) 0.65 (1.07) 0.49 (1.02) 0.46 (0.82) 0.49 (0.92) 0.42 (0.90) 0.54 (1.02) 0.78 (1.09) 0.33 (0.71)

Veau 1 (37) Veau 2 (106) Veau 3 (178) Veau 4 (92)

CL þ A (9) P value

.022 a

.823

.298

.577

<.001

.503

.407

Extent of UCL deformity (n) Incomplete (22)

9.99 (4.53) 8.33 (3.82)

3.00 (3.77) 4.41 (4.19)

1.18 (1.18) 1.52 (1.17)

0.50 (0.86) 1.00 (1.24)

0.59 (0.91) 0.95 (1.19)

0.45 (0.80) 0.27 (0.77) 0.42 (0.82) 0.52 (0.93)

Complete (104)

P value

.105

.0713

.195

.081

.197

.882

.182

Extent of BCL deformity (n) Incomplete (24)

11.02 (5.20) 10.01 (3.86)

3.02 (4.58) 4.44 (5.05)

1.04 (1.08) 1.41 (1.32)

0.63 (1.01) 0.94 (1.19)

0.92 (1.18) 1.16 (1.27)

0.54 (0.88) 0.79 (1.28) 0.47 (1.11) 0.47 (1.05)

Complete (32)

P value

.427

.681

.352

.301

.510

.229

.312

Most Recent NOSE Score, mean (SD)

Age Surveyed Composite Congestion Blockage Nose Breathing

Sleeping

Exercise

All phenotypes (n ¼ 456) Classification (n) Submucosal cleft (34)

10.10 (4.48)

2.65 (3.34)

0.97 (1.03)

0.46 (0.84)

0.58 (0.95)

0.34 (0.78) 0.31 (0.79)

8.59 (4.59) 7.36 (3.36) 10.19 (5.06) 10.09 (4.17) 11.91 (4.04) 7.89 (2.89)

2.62 (2.95) 1.68 (2.27) 2.76 (3.63) 2.76 (3.23) 2.59 (3.63) 4.11 (3.72)

1.09 (1.00) 0.78 (0.98) 0.99 (0.99) 1.04 (1.06) 0.82 (1.06) 1.22 (1.09)

0.35 (0.65) 0.16 (0.44) 0.47 (0.89) 0.52 (0.85) 0.42 (0.88 ) 1.11 (1.17)

0.50 (0.79) 0.35 (0.79) 0.59 (0.99) 0.61 (0.94) 0.60 (1.04) 0.78 (0.97)

0.47 (0.96) 0.21 (0.64) 0.27 (0.65) 0.11 (0.39) 0.39 (0.88) 0.32 (0.82) 0.29 (0.67) 0.30 (0.76) 0.32 (0.77) 0.43 (0.98) 0.67 (1.11) 0.33 (0.71)

Veau 1 (37) Veau 2 (106) Veau 3 (178) Veau 4 (92)

CL þ A (9) P value

.050 a

<.001

.329

.236

.610

.768

.415

Extent of UCL deformity (n) Incomplete (22)

10.65 (4.32) 8.97 (3.71)

2.36 (3.47) 2.96 (3.38)

1.05 (1.13) 1.05 (1.09)

0.41 (0.85) 0.61 (0.92)

0.41 (0.85) 0.63 (0.91)

0.23 (0.61) 0.27 (0.77) 0.34 (0.77) 0.35 (0.81)

Complete (104)

P value

.084

.325

.962

.241

.207

.496

.570

Extent of BCL deformity (n) Incomplete (24)

11.50 (4.96) 10.47 (3.60)

2.67 (3.48) 3.41 (4.65)

0.71 (0.91) 1.03 (1.28)

0.42 (0.72) 0.69 (1.12)

0.58 (0.97) 0.94 (1.27)

0.42 (0.72) 0.54 (1.14) 0.31 (0.85) 0.44 (1.01)

Complete (32)

P value

.417

.790

.477

.515

.379

.185

.762

Abbreviations: BCL, bilateral cleft lip; NOSE, Nasal Obstruction Symptom Evaluation; SD, standard deviation; UCL, unilateral cleft lip. Note: Bold and italic values indicate statistically significantly different values between groups. a Indicating statistical significance ( p value <0.05)

differentiation between unilateral and bilateral deformities. The results of this study suggest that CL phenotype, regardless of the presence or extent of CP deformity, may be more sig- nificant with regard to nasal obstruction. Sobol et al. (2016) found that subjects with isolated CL (either with or without alveolus) reported nasal obstructive symptoms at similar frequencies as unaffected children. In contrast, the subjects with CL þ A in this study reported the most severe symptoms. However, Sobol et al were not able to differentiate between subjects with isolated CL without alveolar involvement (for whom nasal septum would remain midline) and subjects with isolated CL with alveolus (for whom the anterocaudal portion of the septum will be deviated). All 9

findings of Sobol et al. Sobol et al also reported that subjects with unilateral CLP reported more severe symptoms that those with bilateral CLP. These findings are expected, given anato- mical studies of unilateral CLP deformity showing progressive anterior caudal septum deviation, bowing of the posterior sep- tum, turbinate hypertrophy, and internal valve narrowing through adolescence (Cheung and Oberoi, 2012; Fisher et al., 2014; Friel et al., 2015). Similar to the findings of Sobol et al, the Veau 3 (unilateral CLP) cohort in this study had more severe reported nasal blockage symptoms compared to the Veau 4 (bilateral CLP) cohort. This study utilized the Veau classification, given it is the classification scheme utilized by the authors’ institution for documentation and encompasses the

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