A Simple Method for Lower Lateral Cartilage Repositioning in Cleft Lip Nose Deformity (original) (raw)
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A new method for the correction of secondary unilateral cleft lip nose
European Journal of Plastic Surgery, 1994
In 1982, Dibbell described a procedure to correct this distortion by rotating and advancing the nostril medially and superiorly. We used this method in our department for several years, but as Dibbell himself experienced, we didn't always obtain satisfactory results. Like many authors, I agree that the best approach for proper correction of the secondary unilateral cleft lip nose deformity is the external approach using transcolumellar incisions, because the lower lateral cartilage exposure is inadequate with Dibbell's method. I added the transcolumellar incision similar to Bardach's to solve this problem. In this paper, this combination technique will be presented and contrasted with Dibbell's and Bardach's techniques.
Correction of Cleft Lip Nose Deformity With Rib Cartilage
Aesthetic Surgery Journal, 2013
Although there are facilities that, in the past 10 years, have treated cleft lip nasal deformities (CLND) via preoperative orthodontic care as well as noninvasive molding accompanied by total lip and limited nasal modifications, 1 such facilities were not and still are not available in Iran. Therefore, patients who underwent attempted surgical correction in previous decades had very severe deformities, and neither patients nor surgeons were satisfied with the surgical outcome or the postoperative nasal appearance. With the use of the Gunter rib cartilage harvesting technique, which involves a minimal incision (4 cm) and less morbidity, 2 rib cartilage grafting has become the main workhorse of CLND surgery. The reasons for using such a strong structure as rib cartilage for the correction of CLND are manifold. Severe weakness, deformity, and collapse of the lower lateral cartilage (LLC) as well as scarring and a short alar line on the cleft side are forces that should be neutralized by a strong, reinforced scaffold to keep the nose in its new position. With severe downward force applied on the columella by
Otolaryngologic Clinics of North America, 1999
Cleft lip nasal deformity has been considered by most surgeons to be a difficult problem to correct. The great multitude of rhinoplasty techniques developed since the 1920s serves as a testament to the difficult nature of the secondary cleft rhinoplasty. All of the techniques address some aspects of the deformity. Completely correcting all of the deficiencies of some cleft lip noses, however, remains an elusive goal. Certainly, each patient presents a unique challenge that may be addressed best with some techniques and not others. To understand what a cleft rhinoplasty technique accomplishes, the secondary deformity of the cleft lip nose must be understood. It must be distinguished from the nasal deformity of the unrepaired cleft of the lip mainly by the position of the alar base. In the repaired lip, the alar base displacement can be largely corrected in some individuals. The unilateral cleft lip nasal deformities result from tissue deficiency of the cleft lip, a deficiency in the maxilla, or abnormal muscular pull on the nasal structures. The "typical" secondary deformity consists of the following: 1. The dome on the cleft side is retrodisplaced. 2. The columella on the cleft side is foreshortened. 3. The medial crus slumps laterally.
Combining the Cutting and Mulliken Methods for Primary Repair of the Bilateral Cleft Lip Nose
Plastic and Reconstructive Surgery, 2005
Background: Since 1990, primary bilateral cleft nasal reconstruction has been focused on placing the lower lateral cartilages into normal anatomical position. Of the four major techniques in this class, the Cutting (i.e., retrograde) method and the Mulliken method have been most successful. The retrograde method makes no external nasal incisions, but requires either preoperative or postoperative nasal molding to achieve maximum benefit. Mulliken's technique does not require molding, but leaves the footplates of the medial crura in the depression above the projecting premaxilla associated with the diminutive anterior nasal spine. Leaving the footplates in place also prevents adequate approximation of the alar bases. In this article, the two methods are combined to achieve the benefits of both. Methods: We report our experience with the retrograde nasal approach associated with marginal rim incisions (Mulliken method) in a series of 25 consecutive bilateral cleft lip cases simultaneous with lip repair. We performed a retrograde approach through membranous septum incisions elevating a prolabial-columellar flap. To facilitate alar cartilage manipulation we added bilateral marginal rim incisions. Nasal width, columella length and width, tip projection, and nasolabial angle were analyzed after a minimum of 2 years after surgery. These were compared with a normal, age-matched, control group. We also examined nostril symmetry and marginal nostril scars. Results: Columellar length was not statistically significantly different from that of the control group (p ϭ 0.122442). Nasal width, columellar width, tip projection, and nasolabial angle were all significantly greater in the cleft group than normal (p Ͻ 0.001). No hypertrophied scars were found associated with the marginal rim scar. Conclusions: Adding the Mulliken approach allows alar cartilage manipulation to be performed more easily than when using the retrograde approach alone. Tip projection and alar base narrowing are facilitated using the combined technique rather than the Mulliken approach alone. Prolabial flap manipulation is safe using this combined approach, even in cases with a severely projected premaxilla. We believe that the combined approach is safe and yields better long-term results than either technique alone.
Objective Tools to Analyze the Lower Lateral Cartilage in Unilateral Cleft Lip Nasal Deformities
Journal of Craniofacial Surgery, 2011
Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.
Comparison of Suture and Graft Techniques in Secondary Unilateral Cleft Rhinoplasty
Journal of Craniofacial Surgery, 2011
Every surgeon should master several techniques to modify the nasal tip. For secondary rhinoplasty, various techniques have been described. A modified technique of using the cephalic trim portion of lower lateral cartilage as onlay tip graft is also described. The objective of this single-blind randomized controlled trial was to compare the outcome of suture-only techniques and grafts-plussuture techniques in terms of postoperative tip projection made measurable by the patient as excellent, good, or poor. Sixty patients with cleft nasal tip deformity who gave informed consent were included and randomly assigned to either technique. Patients requiring osteotomies and previously operated on for cleft rhinoplasty were excluded. Postoperative tip projection was assessed by the patient 6 months postoperatively. Mean age was 28.5 T 2.1 years in suture technique (group A) and 29.1 T 1.9 in suture-plus-graft technique (group B). There were 20 males (66.7%) and 10 females (33.3%) in group A and 22 males (73.3%) and 8 females (26.5%) in group B. Nasal deformity was moderate in 66.7% of cases in group A and 60.0% of cases in group B, whereas nasal deformity was severe in 33.3% of cases in group A and 40% of cases in group B. Postoperative tip projection was excellent in 7 patients (23.3%) in group A and 22 patients (73.3%) in group B, and good in 4 patients (13.3%) in group A and 5 patients (16.7%) in group B, whereas poor results were observed in 19 patients (63.4%) in group A and 3 patients (10.0%) in group B (P = 0.001). Graft-plus-suture technique is an effective method for improving the tip projection.
Oral and Maxillofacial Surgery for the Clinician, 2021
Cleft rhinoplasty is one of the most difficult and challenging aesthetic surgeries to carry out and bears a significant impact on the overall nasal aesthetics and function. Two reasons understood for this are the simultaneous involvement of all the layers of the nose including the skin, cartilage, skeleton and vestibular lining (this being the principal reason) and the significant scarring that is the consequence of multiple previous surgical interventions. There is a mention of numerous techniques for ultimate correction of unilateral and bilateral cleft nasal deformities but no single technique has till date provided a definite solution for correction of all the problems that accompany these deformities. There is a revised interest in performing primary rhinoplasties at the time of lip repair with or without presurgical orthopedics but these procedures may still warrant definitive rhinoplasty at a later date. The purpose of this chapter is to provide a comprehensive review of clef...
European Journal of Dentistry, 2016
high levels of maternal estrogen in the fetal circulation. The hormone increases the hyaluronic acid level which alters the elasticity of cartilage, ligament, and the connective tissue. [3-5] Nasoalveolar molding (NAM) technique has various advantages. (1) It is used for symmetrical re-contouring of the nasal cartilage on the defective side. (2) It is used to mold and approximate the alveolar process of the maxillary arch before surgical correction of the cleft lip. (3) Effective retraction of protruded premaxilla is observed. (4) Lengthening of deficient columella is also found. (5) It reduces the need for