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Facial Plastic and Reconstructive Surgery

Pathophysiology of Nasal Airway Obstruction in Cleft and Noncleft Patients

Tuesday, October 3, 2023
1:48 PM - 1:54 PM East Coast USA Time
Location: 205ABC

    Presenting Author(s)

  • Sarah M. Russel, MD, MPH

    Resident Physician, Postdoctoral Research Fellow
    University of North Carolina - Chapel Hill, Department of Otolaryngology/Head and Neck Surgery
    Chapel Hill, North Carolina, United States

    • Co-Author(s)

  • RS

    Reanna Shah, MD Candidate, B.S.

    Research Associate
    Duke University, Department of Head and Neck Surgery and Communication Sciences
    Durham, NC, United States

  • JM

    Jeffrey R. Marcus, MD

    Chief, Division of Plastic, Maxillofacial and Oral Surgery
    Duke University, Department of Surgery
    Durham, NC, USA

    • Senior Author(s)

  • DF

    Dennis O. Frank-Ito, PhD

    Associate Professor
    Duke University, Department of Head and Neck Surgery and Communication Sciences
    Durham, NC, USA

Disclosure(s):
Sarah M. Russel, MD, MPH: No relevant relationships to disclose.
Introduction: Patients with unilateral cleft lip nasal deformities (uCLND) experience significant nasal airway obstruction (NAO), but little is known about how this congenital anomaly alters nasal airflow. This prospective cohort study aims to compare patients with uCLND to patients with non-cleft NAO and healthy controls to better understand how uCLND affects nasal airflow.

Methods: Patients were recruited from an ongoing study (November 2019 - present) for 30 subjects in 3 cohorts: 5 uCLND, 10 non-cleft NAO, and 15 healthy controls. All subjects provided nasal obstruction symptom evaluation (NOSE) scores and underwent cone beam computed tomography scans, which were used to create patient-specific models of nasal airways. Computational fluid dynamics (CFD) simulations were run at 15L/min flow rate, and nasal airway resistances were calculated. The more obstructed side in the uCLND and NAO cohorts was compared to the side in healthy controls with greater airway resistance. Kruskal-Wallis test was used to compare nasal resistances among all three cohorts.

Results: Mean (±standard deviation) NOSE scores were (p < 0.001): uCLND=49±23, NAO=74±18, and Healthy=6±8. Bilateral nasal resistance (Pa.s/mL) was statistically significantly different among all three cohorts (uCLND=0.160±0.125, NAO=0.146±0.120, and Healthy=0.049±0.022, p< 0.001). The same was true when comparing unilateral nasal resistance (Pa.s/mL) on the more obstructed side (uCLND=0.958±0.585, NAO=0.446±0.468, and Healthy=0.127±0.059, p< 0.001) and less obstructed side (uCLND=0.190±0.130, NAO=0.216±0.136, and Healthy=0.081±0.038, p=0.001).

Conclusions: Preliminary results suggest that patients with uCLND underreport the severity of their nasal obstruction compared to non-cleft patients with NAO, yet objective findings indicate that patients with uCLND have greater severity of nasal obstruction. Unilateral resistance on the side with greater resistance among the healthy cohort was lower than resistance values on the less obstructed side for uCLND and non-cleft patients with NAO.