Management of the Mestizo Nose.

Mestizo noses have mesorrhine nasal characteristics. They have a modest osteocartilaginous framework, nasal tips that tend to be bulbous with poor projection and rotation, and skins that tend to be thick and acne prone. A structural rhinoplasty approach is performed, focusing on anatomic findings. Conservative tissue excision with preservation or reinforcement of support structures of the nose is done. Structural grafting and suturing techniques are used to remodel cartilage and create better definition and support. The skin and soft tissue envelope is managed medically and surgically. The objective is to create balanced-looking noses that bring patients closer to their own aesthetic ideal.

Consumer Prices for Surgical Management of End-Stage Hallux Rigidus.

Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers' decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.Levels of Evidence: IV, basic science.

Cost-efficacy of Knee Cartilage Defect Treatments in the United States.

BACKGROUND: Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood. PURPOSE/HYPOTHESIS: The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost <$50,000 per quality-adjusted life-year over 10 years. STUDY DESIGN: Systematic review. METHODS: A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure. RESULTS: Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm2 to 36.0 for OCA of bipolar lesions. Failure rates ranged from <5% for osteochondral autograft for defects requiring 1 or 2 plugs to 46% for OCA of bipolar defects. All treatments were cost-effective over 10 years in the baseline model if costs were increased 50% or if failure rates were increased an additional 15%. However, if efficacy was decreased by a minimum clinically important amount, then ACI (periosteal cover) of femoral condylar lesions ($51,379 per quality-adjusted life-year), OCA of bipolar lesions ($66,255) or the patella ($66,975), and microfracture of defects >3 cm2 ($127,782) became cost-ineffective over 10 years. CONCLUSION: Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm2. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously.

The cost-effectiveness of osteochondral allograft transplantation in the knee.

PURPOSE: Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee. METHODS: Systematic review of evidence on clinical effectiveness and economic modelling. RESULTS: The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective. CONCLUSIONS: Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed. LEVEL OF EVIDENCE: II.

Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty.

INTRODUCTION: Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique. METHODS: It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P<0.05. RESULTS: Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P<0.001. CONCLUSIONS: Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.

Assessment of Vertical Triangular Spreader Graft Technique for Reconstruction of Middle Vault and Internal Nasal Valve Angle.

BACKGROUND: Rhinoplasty is a surgical procedure to smooth out the nasal deformities and to fix nasal breathing problems. Spreader grafts and flaps are used to prevent some complications such as middle vault collapse, narrowing the internal nasal valve and inverted V deformity. To obtain more stable middle vault, spreader grafts and flaps could be used together. Many researchers have tried different graft and flap techniques to reach more successful aesthetic and functional results. In this research, we investigated effects of triangular graft on the internal nasal valve angle, nasal breathing, and aesthetic outcomes when it used together with sprader flap. METHODS: In this prospective study, 3 different groups were formed as: the spreader flap group (group 1); the spreader flap with the rectangular spreader graft group (group 2); and the spreader flap with the triangular spreader graft group (group 3). Preoperative nasal obstruction symptom evaluation (NOSE) scale was used to evaluate nasal breathing and visual analog scale (VAS) was used to evaluate aesthetic appearance. And also, measurement of the internal nasal valve angle was performed for each patients. These evaluations were repeated at postoperative 3rd month. Preoperative and postoperative comparisons between study groups were performed. RESULTS: There were 12 patients in group 1, 14 patients in group 2, and 10 patients in group 3. In each group, statistically significant decrease in NOSE scores (P < 0.05) and statistical significant increase in VAS scores (P < 0.05) were observed. And also, increased internal nasal valve angle after surgery was detected in all groups (P < 0.05). Postoperative NOSE and VAS scores were found similar in 3 different groups (P > 0.05). On the contrary, the internal nasal valve angles were found statistically significant increased in group 3 according to other groups (P < 0.05). CONCLUSION: The results of this prospective study presented that the use of triangular spreader graft with spreader flap was an appropriate technique to obtain successful aesthetic and functional outcomes with widening the internal nasal valve angle.

Outcome and cost analysis of bilateral sequential same-day cartilage tympanoplasty compared with bilateral staged tympanoplasty.

BACKGROUND: Few studies have compared bilateral same-day with staged tympanoplasty using cartilage graft materials. METHODS: A prospective randomised observational study was performed of 38 chronic suppurative otitis media patients (76 ears) who were assigned to undergo bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential tympanoplasty performed 3 months apart (20 patients, 40 ears). Disease duration, intra-operative findings, combined duration of surgery, post-operative graft appearance at 6 weeks, post-operative complications, re-do rate and relative cost of surgery were recorded. RESULTS: Tympanic membrane perforations were predominantly subtotal (p = 0.36, odds ratio = 0.75). Most grafts were harvested from the conchal cartilage and fewer from the tragus (p = 0.59, odds ratio = 1.016). Types of complication, post-operative hearing gain and revision rates were similar in both patient groups. CONCLUSION: Surgical outcomes are not significantly different for same-day and bilateral cartilage tympanoplasty, but same-day surgery has the added benefit of a lower cost.

Assessment of the Factors That Affect the Anatomic and Functional Success of Cartilage Tympanoplasty in Children.

OBJECTIVES: Many factors may influence the surgical outcome of tympanoplasty in children, including age, the size and location of perforation, otorrhea, status of contralateral ear, surgical technique, and adenoid hypertrophy. This study aims to evaluate the outcomes of pediatric cartilage tympanoplasty and to assess the factors that affect the success of tympanoplasty in children. METHODS: Children with chronic otitis media who underwent tympanoplasty using cartilage as graft material were evaluated retrospectively. Patient age, gender, size and site of the perforation, status of the contralateral ear, preoperative and postoperative hearing levels, surgical technique, and postoperative complications were noted. RESULTS: Of the 72 patients included in the study, 27 were male and 35 were female. The average age was 13.22 ±â€Š2.64 and mean follow-up time was 18.4 ±â€Š8.62 months. Anatomic and functional success rates were 88.8% and 80.6%, respectively. Age, gender, and the status of the contralateral ear had no effect on surgical success rate. The mean preoperative and postoperative pure-tone averages were 33.2 6±â€Š10.37 and 21.00 ±â€Š13.25 dB, respectively. CONCLUSION: Anatomic and functional outcomes of cartilage tympanoplasty are quite satisfactory in pediatric patients. Chronic otitis media should be treated surgically as early as when patient cooperation is possible.

An Economical Approach to Ethnic Asian Rhinoplasty.

Septal cartilage is deficient in Asians seeking augmentation rhinoplasty. Economized utilization of resources is necessary for durable tip enhancement that complements a dorsal implant. We introduce a modified tongue-in-groove method designed to transmit forces across the dorsum, eliminating the need for robust caudal support and prioritizing nasal lengthening and tip projection. We aim to promote the roundness index parameter and demonstrate the feasibility of a novel method in the context of Asian rhinoplasty. Between 2012 and 2014, a total of 104 Taiwanese patients underwent rhinoplasty with dorsal augmentation and lengthening with a modified tongue-in-groove technique. The concept borrows from methods established by Byrd, Guyuron, and Toriumi but distinguished by exaggerated forward positioning of a septal extension graft. Paired extended spreader grafts obviate the need for a columellar strut. Soft-tissue changes were analyzed with photogrammetry. A new parameter, the roundness index, was measured. Tip projection, dorsal length, nasal height, alar and columellar length increased significantly after 5.5 months of follow-up. Nasal tip angle, roundness, columella-labial angle, and nostril axis inclination decreased. There were no statistically significant differences in the magnitude of change in patients followed for less than and greater than 6 months. The most common complication was new or persistent tip deviation in five cases (5%). This technique was designed for a nasal anatomy typified by deficient septal cartilage. Significant photogrammetric changes were maintained after 6 months. Economized tissue allocation, dorsal septal load sharing, and relative independence from caudal support are key features of this feasible method.

Rib Cartilage Assessment Relative to the Healthy Ear in Young Children with Microtia Guiding Operative Timing.

BACKGROUND: The optimal age at which to initiate for auricular reconstruction is controversial. Rib cartilage growth is closely related to age and determines the feasibility and outcomes of auricular reconstruction. We developed a method to guide the timing of auricular reconstruction in children with microtia ranging in age from 5 to 10 years. METHODS: Rib cartilage and the healthy ear were assessed using low-dose multi-slice computed tomography. The lengths of the eighth rib cartilage and the helix of the healthy ear (from the helical crus to the joint of the helix and the earlobe) were measured. Surgery was performed when the two lengths were approximately equal. RESULTS: The preoperative eighth rib measurements significantly correlated with the intraoperative measurements (P < 0.05). From 5 to 10 years of age, eighth rib growth was not linear. In 76 (62.8%) of 121 patients, the eighth rib length was approximately equal to the helix length in the healthy ear; satisfactory outcomes were achieved in these patients. In 18 (14.9%) patients, the eighth rib was slightly shorter than the helix, helix fabrication was accomplished by adjusting the length of the helical crus of stent, and satisfactory outcomes were also achieved. Acceptable outcomes were achieved in 17 (14.0%) patients in whom helix fabrication was accomplished by cartilage splicing. In 9 (7.4%) patients with insufficient rib cartilage length, the operation was delayed. In one (0.8%) patient with insufficient rib cartilage length, which left no cartilage for helix splicing, the result was unsatisfactory. CONCLUSIONS: Eighth rib cartilage growth is variable. Rib cartilage assessment relative to the healthy ear can guide auricular reconstruction and personalize treatment in young patients with microtia.

Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI.

BACKGROUND: Zonal T2 mapping and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) are diagnostic quantitative techniques to evaluate the biochemical health of articular cartilage. We adapted these techniques to investigate the results of osteochondral allograft transplantation and correlated the findings with patient-reported outcomes. METHODS: Nine patients with contained ICRS (International Cartilage Repair Society) grade-4 defects of the articular portion of a femoral condyle were treated with fresh osteochondral allografts and were evaluated prospectively with dGEMRIC and T2 mapping before and after gadolinium administration. The KOOS (Knee Injury Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee) subjective scores were obtained at baseline and at one and two years postoperatively. For quantitative T2 mapping, regions of interest were drawn in the deep and superficial layers of allograft and control cartilage. For dGEMRIC analyses, the relaxation rate, post-gadolinium change in relaxation rate, and ratio between changes in the allograft and control regions of interest were calculated from T1 values. RESULTS: The mean ratio between the post-gadolinium changes in the allograft and control cartilage was 1.13 at one year and 1.55 at two years, and the ratio increased in eight of nine patients from one to two years. There was no difference between the mean T2 values in the deep zone of the allograft and control cartilage at one or two years (p > 0.05), but mean T2 values were higher in the superficial zone of the allograft cartilage at one (p < 0.0001) and two (p < 0.028) years. The mean improvement from baseline was significant at one and two years for the IKDC and all five KOOS subdomains (p < 0.05). All or nearly all patients showed improvements in all clinical outcomes scores at one year. CONCLUSIONS: Functional MRI techniques can be applied to noninvasively assess the biochemical health of cartilage after osteochondral allograft transplantation. The MRI findings correlated with certain patient-reported outcomes in the early postoperative period. Relative glycosaminoglycan content and the collagen structure of allograft cartilage may undergo time-dependent degeneration. A patient's perception of clinical outcome and quality of life is likely multifactorial and is impacted by more than the health of the allograft cartilage.

Three-dimensional suitability assessment of three types of osteochondral autograft for ulnar coronoid process reconstruction.

BACKGROUND: Osteochondral autografts with use of the olecranon tip, lateral radial head, or proximal radial head have been employed for coronoid process reconstruction. However, it is unclear which autograft is most suitable for coronoid articular configuration. We assessed 3-dimensional articular facet suitability of 3 osteochondral autografts for coronoid process reconstruction. METHODS: We performed 3-dimensional computed tomography of 20 elbows to compare the articular facet configuration between the coronoid process and the ipsilateral olecranon tip, lateral radial head, and proximal radial head. We measured the area of the proximity region (≤2.0 mm) between the articular facets of the coronoid process and 3 osteochondral autografts, the covering rate defined as the percentage area of the coronoid articular facet occupied by the proximity region, the location of the proximity region center, and the percentage of the removed ulnohumeral articular facet. RESULTS: The covering rate was significantly higher with an olecranon graft than with radial head grafts. The regional center of a proximal radial head graft was significantly medial compared with that of olecranon and lateral radial head grafts. The olecranon graft used an average of 13.8% of the ulnohumeral articular facet. CONCLUSIONS: An olecranon graft was most suitable for defects of the coronoid process involving the tip, and a proximal radial head graft was most suitable for defects of the coronoid process involving the anteromedial rim. The use of an olecranon graft for reconstruction of 50% of the height of the coronoid process does not cause concern for gross elbow instability.

Assessment of the 18-month permanence of onlay tip cartilage grafts following rhinoplasty.

Augmentation rhinoplasty requires addition of materials of various natures to reshape the nasal pyramid. Onlay tip grafts are single or multilayered grafts placed horizontally over the alar domes. The aim of the present study was to assess the 18-month permanence of onlay septal cartilage grafts. Twenty-eight patients underwent rhinoplasty with onlay tip cartilage graft, between June 2008 and November 2008 at the Campus Bio-Medico University in Rome, Italy. They were reviewed and photographed 6 months and 18 months postoperatively. Comparison of 6-month and 18-month postoperative pictures was performed with Adobe Photoshop CS. Measurements on pictures were taken with AutoCAD. Comparison of photographs showed no visible difference in nasal tip projection. Comparison of the measurements of tip projection showed a mean reduction of 0.06 mm (0.19%). Considerable stability of nasal tip projection after rhinoplasty with onlay tip grafts was observed postoperatively. Comparison of standardised digital photographs is a valid procedure to assess contour alterations of various anatomical structures after plastic surgery.

Assessment of nostril symmetry after primary cleft rhinoplasty in patients with complete unilateral cleft lip and palate.

The aim of this study was to assess the nostril symmetry following primary cleft rhinoplasty done with either a dorsal onlay or columellar strut graft in patients with non-syndromic complete unilateral cleft lip and palate. In this retrospective study 30 consecutive patients treated with autogenous or alloplastic dorsal onlay grafts and 30 consecutive patients treated with autogenous or alloplastic columellar strut grafts for complete unilateral cleft nose reconstruction were analyzed for nasal symmetry. The autogenous grafts used were costo-chondral or septal cartilage and the alloplastic graft used was high density polyethylene (Medpore(®)). Assessment of the nostril symmetry was done using a two-dimensional nasal analysis 24-30 months postoperatively. Ratios between cleft and noncleft side nostril for three parameters were used to assess symmetry namely nostril width, nostril height and nostril gap area. None of the three parameters showed statistically significant changes. A satisfactory, though not statistically significant, difference in symmetrical outcome could be achieved in both the groups with the exception of nostril width symmetry in group treated with dorsal onlay graft.

Health-related quality-of-life assessment and surgical outcomes for auricular reconstruction using autologous costal cartilage.

BACKGROUND: This study aims to assess the health-related quality-of-life benefit following auricular reconstruction using autologous costal cartilage in children. In addition, key aspects of the surgical reconstruction are assessed. METHODS: After auricular reconstruction, patients completed two questionnaires. The first was a postinterventional health-related quality-of-life assessment tool, the Glasgow Benefit Inventory. A score of 0 signifies no change in health-related quality-of-life, +100 indicates maximal improvement, and -100 indicates maximal negative impact. The second questionnaire assessed surgical outcomes in auricular reconstruction across three areas: facial integration, aesthetic auricular units, and costal reconstruction. These were recorded on a five-point ordinal scale and are presented as mean scores of a total of 5. RESULTS: The mean total Glasgow Benefit Inventory score was 48.1; significant improvements were seen in all three Glasgow Benefit Inventory subscales (p < 0.0001). A mean integration score of 3.8 and a mean aesthetic auricular unit reconstruction score of 3.4 were recorded. Skin color matching (4.3) of the ear was most successfully reconstructed and auricular cartilage reconstruction scored lowest (3.5). Of the aesthetic units, the helix scored highest (3.6) and the tragus/antitragus scored lowest (3.3). Donor-site reconstruction scored 3.9. Correlation analysis revealed that higher reconstruction scores are associated with a greater health-related quality-of-life gain (r = 0.5). Ninety-six percent of patients would recommend the procedure to a friend. CONCLUSIONS: Auricular reconstruction with autologous cartilage results in significant improvements in health-related quality-of-life. In addition, better surgical outcomes lead to a greater improvement in health-related quality-of-life. Comparatively poorer reconstructed areas of the ear were identified so that surgical techniques may be improved. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Effects of D-DRG system on hospital financing on the example of septorhinoplasty]. / Die Kostenabbildung der Septorhinoplastik im D-DRG System.

INTRODUCTION: Since the introduction of DRGs (diagnosis related groups) 2004, the septorhinoplasty, regardless whether an open or closed approach is chosen or whether orthotopic cartilage or autologous cartilage is required and whether a complex deformity (patients with cleft palate) or post-traumatic deformities are treated in the adult all procedures are valued the same. The aim of the study was to investigate at a center for rhino-surgery the real effort for the different diseases and to assess the necessity of a new split in the DRG for septorhinoplasty. METHODS: Retrospective study of all patients, who were treated from January 2006 to December 2009 at the ENT Clinic of the University of Ulm with a septorhinoplasty/septal perforation closure in terms of duration of surgery and the material consumption. RESULTS: In the years 2006-2009 at the ENT Clinic in Ulm 705 septorhinoplasties were performed, 124 were revision surgeries, 216 with ear cartilage and 35 with rib cartilage. In 66 cases nasal deformities due to cleft palate was treated. The duration of surgery of the different septorhinoplasties differed statistically significant from each other, also the material consumption/material costs. CONCLUSION: A re-organization of the DRG D 37 can be justified with varying surgery time and material consumption for each operation type. A proposal is presented.

Revision rhinoplasty in asians.

Revision rhinoplasty is increasing in the Asian population. We present causes of revision rhinoplasty in Asians, introduce operative techniques, report surgical results, and make implications for ways to assist in their prevention. During a period of 3 years, 52 patients (among 623 rhinoplasties) who had undergone revision rhinoplasty with at least 1 year follow-up were included in this study. A retrospective review was performed using chart review, graphic operation records, pre- and postoperative photographs. Outcome was determined by subjective assessment of 2 blinded rhinoplasty surgeons. The patients were classified into 2 groups; revision because of alloplastic implant-related problems (33 cases) and revision unrelated to alloplastic implants (19 cases). The most common reason for revision in the alloplastic implant-related group was deviation of the implant, followed by implant extrusion, foreign body reaction, and infection. Reasons for revision in the alloplastic implant-unrelated group included upper two-thirds problems in 12 cases, and tip problems in 7. Autologous cartilage was used in the majority of revision cases. Subjective evaluation of postoperative results were good in 29 (69%), fair in 10 (24%), and poor in 3 (7%). Revision rhinoplasty in Asians was most commonly associated with alloplastic implants. Proper and judicious use of alloplastic implants is important to reduce the chances for revision surgery in Asians.

3D Stereophotogrammetric assessment of pre- and postoperative volumetric changes in the cleft lip and palate nose.

In cleft lip and palate patients the shape of the nose invariably changes in three dimensions (3D) due to rhinoplastic surgery. The purpose of this study was to evaluate stereophotogrammetry as a 3D method to document volumetric changes of the nose in patients with a cleft lip (CL) or cleft lip and palate (CLP) after secondary open rhinoplasty. 12 patients with unilateral CL or CLP were enrolled in the study prospectively. 3D facial images were acquired using 3D stereophotogrammetry preoperatively and 3 months postoperatively. A 3D cephalometric analysis of the nose was performed and volumetric data were acquired. The reliability of the method was tested by performing an intra- and inter-observer analysis. Left, right and total nasal volumes and symmetry were compared. No statistically significant differences (p<0.05) were found within and between observers for the measured volumes and symmetry. Postoperatively, the total volume of the nose increased significantly, especially the volume at the cleft side. No significant volume difference pre- and postoperatively was found for the non-cleft side. The symmetry of the nose improved significantly. 3D stereophotogrammetry is a sensitive, quick, non-invasive method for evaluating volumetric changes of the nose in patients with cleft lip or cleft lip and palate.