The “Anatomical Balance Correction” for Secondary Cleft Lip Nasal Deformities (original) (raw)

Tip Rhinoplasty in Cleft Lip Nasal Deformity

2015

It is important to identify the aim of the rhinoplasty in cleft lip nasal deformities as to restore the nasal symmetry, improvement of the nasolabial and naso-facial relationship with minimal evidence of surgical intervention as well as the functional objectives as patent air way, proper position of the maxilla and achievement of normal speech [2]. Rhinoplasty in cleft lip nasal deformities could be performed either primary or secondary after repair of the cleft lip. Primary correction has been reappraised in the last two decades having particular advantages as more symmetrical nose and better appearance in the early life. Even when rhinoplaty is re-required after nasal growth is complete, the deformity is less severe and more amenable final results [3].

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

Indian Journal of Plastic Surgery, 2009

The treatment of patients with unilateral cleft lip has undergone signiÞ cant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treatment protocols, and constant striving for perfection in both aesthetics and function, we have been able to design improved treatment strategies and more accurate surgical techniques so as to achieve overall superior and long-lasting results. In this review article, we present our protocols and experience for functional and aesthetic correction of secondary unilateral cleft lip nasal deformities and a retrospective review of 219 consecutive patients treated at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities. The protocols used in the treatment of 219 consecutive patients at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities were reviewed. In addition, analysis of the most recent 51 consecutive patients who underwent complete clinical and functional evaluation with rhinomanometry followed by correction of the cleft lip nasal deformity was performed. A variety of time-honoured techniques of rhinoplasty were applied in the correction of the residual deformities to achieve symmetry, aesthetic balance, and functional correction of the nose. Follow-up ranged from 5-11 years. Analysis of the data revealed that 39 patients (76.47%) had signiÞ cant functional and aesthetic improvement; seven patients (13.07%) had signiÞ cant aesthetic improvement but a modest functional improvement; and Þ ve patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that Þ ve out of seven patients in the second group had pharyngeal ß aps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these ß aps because the speech was excellent. The surgical plan is based on the information gained from our extensive clinical evaluation and is tailored to the patient's speciÞ c functional and aesthetic needs.

Improved Nasal Tip Projection in the Treatment of Bilateral Cleft Nasal Deformity

Journal of Craniofacial Surgery, 2005

The cleft nose deformity in bilateral cleft lip and palate patients with severely flattened alar cartilages, a short, scarred columella, and thickened skin is a reconstructive challenge. The Wolfe double-arch tip rhinoplasty technique was compared with a cartilage release and tip grafting technique to determine the optimal modality for tip projection and columella lengthening. Patients with significant bilateral cleft nasal deformities and previous bilateral cleft lip repairs were divided into two groups (n = 22). Group 1 (double-arch) patients underwent an open rhinoplasty using conchal cartilage grafts to create a columellar strut and new lower lateral arches placed over the existing arches (n = 12). In group 2 (release and tip graft), the lower lateral cartilages were released, and nasal tip grafting was performed (n = 10). Preoperative and 6-month postoperative measurements, including (1) columellar length, (2) alar base-nasal tip-columellar base (ATC) angle, and (3) lateral tip projection, were compared. The lateral tip projection is the perpendicular distance between the nasal tip and a line created from the connection of points at the nasion to the subnasale. In group 1 (double arch), the mean columella length increased 47.2%, whereas in group 2 (release and tip graft), it only increased 14.1%. The ATC angle had a mean decrease or narrowing of 26.7°in group 1, compared with a 12.5°decrease in group 2. Lateral tip projection improvement was greater in group 1 (52.2% increase) compared with group 2 (19.9% increase). The authors' data showed that for the difficult bilateral cleft nasal deformity with significant tip flattening, the double-arch tip rhinoplasty provides improved nasal tip projection.

Secondary Unilateral Cleft Lip Nasal Deformity: Functional and Esthetic Reconstruction

Journal of Craniofacial Surgery, 2003

Secondary correction of residual unilateral cleft lip nasal deformities is necessary in a number of patients for functional and cosmetic purposes. Myriads of techniques and modifications have been reported. Most of these publications, however, deal with the correction of the esthetic aspects of the deformity, and little attention has been given to the functional problems associated with the deformity and to the functional outcome of these procedures. A comprehensive protocol of care for correction of residual nasal deformities describing our preoperative anatomical and physiological evaluation, our surgical techniques, and postoperative outcome is presented here. The first 30 consecutive patients managed with this protocol were evaluated clinically and physiologically with rhinomanometry. Significant functional improvement was identified in 73.3% of our patients. It is recommended that airway obstruction be evaluated and addressed in all patients with residual cleft nasal deformities. Component rhinomanometry provides objective information about airway obstruction, and postoperative testing and comparison with preoperative data provide for an objective evaluation of results and assist the surgeon to evaluate the outcome of all procedures critically and to modify or improve them appropriately.

Changes in Nose Symmetry in Unilateral Cleft Lip and Palate Treated by Differing Pre-surgical Assistance: An Objective Assessment of Primary Repair

Journal of Cranio-Maxillofacial Surgery, 2015

Backgound: Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction. Methods: Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, 05 confidence. Results: Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p ¼ 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p ¼ 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p ¼ 0.0015), nares "offset" (p ¼ 0.002), and columella symmetry (p ¼ 0.022) with nosetreatment achieving near ideal columella symmetry score (0.92) vs. (0.81). Conclusions: NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.

A panel based assessment of early versus no nasal correction of the cleft lip nose

British Journal of Plastic Surgery, 1993

There is a need to be able to assess the overall result in a significant series of cases of a method of management of the cleft lip and nose deformity in order to avoid "best case" reporting often used to introduce new techniques. The present study was performed by a panel placing standardised base view photographs in rank order. The photographs were of lo-year-old subjects of whom 15 were normal controls, 22 were from the Rikshospitalet, Oslo, all of whom had no primary nasal correction and 25 from Frenchay Hospital, Bristol, who all had radical primary nasal correction.

Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients’ Perspective

Plastic Surgery International, 2014

The correction of cleft lip nasal deformity is challenging and there have been numerous methods described in the literature with little demonstrated technical superiority of one over another. The common clinical issues associated with cleft lip nasal deformity are its lack of symmetry, alar collapse on the affected side, obtuse nasal labial angle, short nasal length, loss of tip definition, and altered columella show among others. We carried out augmentation of cleft lip rhinoplasties with rib graft in 16 patients over the one-year study period. Each of these patients was reviewed and given questionnaire before and after surgery to evaluate their response on the outcome to the approach. Preoperatively, nasal asymmetry is the main complaint (14/16, 87.5%) among our series of patients. Postoperatively, 12 (75%) patients out of the 16 reported significant improvement in their nasal symmetry with the other four marginal. All patients reported excellent nasal projection postoperatively w...

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients ’ Perspective

2015

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The correction of cleft lip nasal deformity is challenging and there have been numerous methods described in the literature with little demonstrated technical superiority of one over another. The common clinical issues associated with cleft lip nasal deformity are its lack of symmetry, alar collapse on the affected side, obtuse nasal labial angle, short nasal length, loss of tip definition, and altered columella show among others. We carried out augmentation of cleft lip rhinoplasties with rib graft in 16 patients over the one-year study period. Each of these patients was reviewed and given questionnaire before and after surgery to evaluate their response on the outcome to the approach. Preoperatively, nasal asymmetry is the main complaint (14/16, 87.5%) among our series of patients. Postoperatively, 12 (75%) patients out of the 16 reported significant...

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.

Combined correction of the nasal tip and upper lip in bilateral cleft lip patients: A novel approach

International Journal of Pediatric Otorhinolaryngology, 2019

Secondary nasal deformity in bilateral cleft lip is one of the great surgical challenges. The problems are an under projected tip, an infra-tip lobule merging with the pro-labium and a short columella. Upper lip vermillion border deformity is a further significant problem. We demonstrate our novel approach to management by classifying patients into 3 groups depending on the status of important features such as the anatomy of the prolabial skin island, length of columella and upper lip width and fullness. We demonstrate that cleft patients with nasal deformity and poor upper lip aesthetics can be managed with a single operation.