الفهرس 
EMBRYOLOGY
Development of musclesOnly 14 pages are availabe for public view
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Abstract
The nasal deformity in unilateral cleft lip and palate is a
social stigma, a burden to the patient and a challenge to the
surgeon. A repaired cleft is revealed more by associated nasal
deformity than by the lip repair line.
If the orbicularis muscle only is repaired, the problems of a
collapsed, imbalanced, and asymmetric nasolabial region after
primary repair are challenging in correcting this deformity. Even
after a good repair that results in an acceptable scar, animation
will often indicate the presence of dysfunctional or misplaced
muscular and cartilaginous tissues.
Meaningful correction of cleft lip with or without palate can
only be achieved when the surgeon is fully aware of normal and
pathologic spatial relations and functions of the anatomic
elements, particularly the muscular elements, which cause the
deformity.
In a complete cleft lip, the muscles of the nasal floor and
the upper lip cannot bridge the gap of the cleft and they cannot
unite with their muscular counterparts on the non cleft side. The
muscular integrity of the region is considerably disrupted, which
has a profound effect on the underlying skeleton. Many surgeons have identified the transverse nasal muscle
as the most important physiologic element in the nasolabial ring.
Together with the orbicularis muscle, they provide support for the
corresponding half of the upper lip and, indirectly, the labial
commissure.
A controlled prospective study was conducted on
patients with complete cleft lip with palate, aged between
months and year. They were divided into two groups. The first
group “control” underwent orbicularis muscle repair only. In the
second group the nasalis muscle was repaired in addition to the
orbicularis muscle and was further divided into subgroups. In
the first subgroup the nasalis origin was repaired, and in the
second subgroup the origin was repaired and the abnormal
insertion was dissected.
Patients were documented pre and postoperatively by
Photography and evaluated subjectively and objectively by three
different methods: cleft lip evaluation profile, nostril angles
measurement, and direct anthropometry.
Analyzing the results of this study makes it clear that
nasalis muscle repair produce better outcome as regards nostril
symmetry, symmetry of the tip of the nose, size and form of the
ala, without hindering growth.
When the nasalis muscle is not reconstructed the action of
the muscles will be imperfect, resulting in dysfunctions that affect subsequent skeletal growth of the face. On the other hand, the
primary nasalis muscle reconstruction restores anatomy, function,
skeletal growth, and total facial aesthetics can be excellent.
Thus the fundamental goal of the surgeon is to achieve
anatomic muscular reconstruction, particularly with respect to
anchorage of the complex nasolabial muscles especially nasalis of
the cleft side to the nasal spine.
Finally, Reconstruction of the nasalis muscle during repair
of cleft lip helps to restore anatomical balance which reduce alar
flaring, narrow the nostril, elevate the nasal sill, and improve
contralateral caudal septal deviation. Therefore, nasalis muscle
reconstruction should be considered in al cases of cleft lip and
palate.
Long term follow up is is highly recommended to predict
the changes occurring after growth and maturation of the face.
Deepening of the alar facial groove was a finding observed
in groups with repaired nasalis muscle, and produced better
aesthetic results. It should be further evaluated since it was not
reflected before in the literature.