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Correction of Cleft Lip Nasal Deformity: A Comparison of Techniques
Author(s) -
Lonergan Devin M.,
Parikh Sachin,
Menard Robert M.,
Friduss Michael E.
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21574
Subject(s) - medicine , head and neck , otorhinolaryngology , head and neck surgery , surgery
cleft lip rhinoplasty has challenged facial plastic surgeons for decades. While many approaches have been described, few techniques have been able to address the multitude of issues facing these patients. Initially, a medially-based chondrocutaneous flap with a division of the lower lateral cartilage was advocated to improve tip symmetry and attempt to improve vestibular stenosis (5). However, without the ability to rotate skin into the vestibule or remove skin from the alar web, an optimal symmetric result and significant improvement in the nasal airway cannot be achieved. Tajima initially described a technique to fully address the nasal alar webbing by incising the skin across the alar-columellar web (6). There was reluctance to accept the inverted U incision across the alar-columellar web as instrumentation of the nasal soft triangle is often ill-advised. However, this incision enables removal of the alar web with the resulting ability to rotate the skin into the deficient vestibule. Vissarionov was the first to suggest that the excess skin could also be transposed into the atretic nasal vestibule from the lip scar (2). This technique allows two-point fixation of the dome allowing further improvement in the vestibular stenosis and resulting nasal airway. Cartilage grafting may be helpful in some instances (7,8). The grafting can help improve nasal tip symmetry and provide strength to columella. However, the excess tissue can result in a bulbous tip. This can frequently cause a displeasing cosmetic result. In our study, we compared the medially-and laterally-based chondrocutaneous flaps. The medially-based flap was somewhat successful in increasing symmetry of the vestibule and dome, however, the alar-columellar web and vestibular stenosis were insufficiently addressed. With the laterally-based flap, patients had markedly improved symmetry of the nasal ala and tip. Further, all patients had improvement in the ability to breathe through their cleft side. Because of our small sample sizes, our findings were not statistically significant. However, they do suggest better results with the laterally-based chondrocutaneous flap.