Effects of premaxillary setback and of prolongation of the columella on the configuration of the facial profile in complete bilateral cleft lip and palate.

Roentgen-cephalometric studies were carried out in 26 adult males with complete bilateral cleft lip and palate. They were subdivided two times in two subgroups, with and without premaxillary setback, and with and without prolongation of the columella. The subgroups were compared mutually, as well as with a group of controls including 50 males matched in age. Premaxillary setback during childhood resulted in a more marked retrusion of the maxilla in adulthood. A simultaneous slighter oral slope of the premaxilla led to a normalization of the upper face height. Skeletal deviations acted on the configuration of the soft profile, in particular of the nasolabial transition: the slope of the columella towards the profile was reduced and so was the nasolabial angle. Thus the region appeared more markedly sunken. This surgical procedure should be used only in an exceptional situation in a small or posteriorly rotated mandible. Prolongation of the columella resulted in an excessive nasal depth. This was not caused by an adequate elevation of the tip of the nose which corrected a flattening of the tip, but rather by the sunken upper lip. An unfavourable effect exerted also a larger deepening of the nasolabial transition after a prolongation of the columella. However a slighter prolongation of the columella did not allow a sufficient elevation of the nasal tip. It is therefore necessary to seek a compromise.