Klinische Studie zur Untersuchung einer möglichen kausalen Beziehung von Ästhetik und Funktion der Nase bei Spaltpatienten

The aim of this investigation was to evaluate whether there may be a causal relationship between form and function of the nose in patients with cleft lip and palate, and if so, whether form has to follow function – or whether function may follow form as well. Two methods were used to measure nasal function: 1. active anterior rhinomanometry during normal breathing, 2. pneumotachygraphy for the registration of the transnasal air flow in speech, with particular attention to possible nasal leakage in the production of oral speech sounds. To this purpose, standardised nonsense speech material was used. Parameters used to represent form were several features of anatomical geometry: width of the nose, ovality and size of the nostrils and columella length. Measurements were performed using photographs taken from three perspectives, en face, laterally and cau-dally. Furthermore, the perception of the quality of nasal breathing by the patients them-selves was assessed using a questionnaire, in order to discover potential relationships between objective instrumental data and subjective responses. The set of patients consisted of 13 boys and 3 girls (average age 11,3 yrs.) who had re-ceived surgical treatment at, and took part in the recall system of, the Department of Oral and Craniomaxillofacial Surgery at Marburg University Hospital. Among the pa-tients there were 5 with an isolated cleft of the palate, 3 with a cleft lip and maxilla, 7 with a unilateral cleft lip and palate and one with a bilateral cleft lip and palate. The set of healthy control subjects consisted of 17 secondary school students (7 boys, 10 girls, average age 13.1 yrs.). Analysing correlations between individual parameters revealed that the initial postulate “form follows function” was confirmed. For some parameters, however, the opposite relation was found (“function follows form”). For example, patients with a unilateral cleft exhibited a narrowed nostril on the cleft side, and at the same time a reduced nasal air flow during normal breathing. From a caudal perspective, most cases with vertically-oval nostrils exhibited a better flow of air than horizontally-oval nostrils. Furthermore there seems to be a certain medium “physiological” range of the width of the nose and the size of the nostril at which transnasal air flow in breathing is highest (i.e. best). Pa-tients with clefts involving the palate had significant transnasal air leakage during speech. It is worthy of note that part of the healthy children with clearly manifest air flow differences between both sides did not perceive any difference. However, percep-tions by the patients relating to this and other functional parameters were highly reliable. It was found that 75 per cent of the patients snored, irrespective of the type of the cleft. The results of the present investigation suggest that the physician’s assessment of the quality of nasal function in patients with cleft lip and/or palate may be facilitated by including some relatively simple measurements of features such as symmetry, width of the nose and ovality of the nostrils, combined with the perception of nasal breathing by the patient himself.