Combined correction of the nasal tip and upper lip in bilateral cleft lip patients: A novel approach (original) (raw)
Related papers
Treatment of Complete Bilateral Cleft Lip-Nasal Deformity
Seminars in Plastic Surgery, 2005
The modern technique of presurgical orthopedics and nasoalveolar molding produces a better skeletal foundation and nasal shape for the repair of the bilateral cleft lip-nasal deformity. The general principles are as follows: (1) preserve the presurgical columellar length; (2) keep the width of the central lip segment narrow without compromising the blood supply; (3) advance the columella prolabium complex superiorly to allow reconstruction of the orbicularis oris muscle behind the prolabium; (4) release the alar cartilage attachment from the pyriform rim and provide additional coverage of this soft tissue deficiency with the use of inferior turbinate flaps; (5) release and reposition the lower lateral cartilage; (6) adequately dissect above the maxillary periosteum; (7) reconstruct the nasal floor by local mucosal flaps; (8) reconstruct the prolabial buccal sulcus with tissue from the prolabium; (9) reconstruct the orbicularis muscle sphincter and attach it to the anterior nasal spine; (10) reconstruct a new Cupid's bow, central vermilion, and lip tubercle with tissue from the lateral lips; (11) balance the height of both lateral lips without any incision around the ala; and (12) maintain the presurgical nasolabial angle. The residual nasal deformity remains a problem that needs further improvement. The long-term result in Chang Gung Craniofacial Center suggests overcorrection of columella height before, during, and after lip repair.
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].
Long-term outcome of simultaneous repair of bilateral cleft lip and nose (a 15 year experience)
British Journal of Plastic Surgery, 2003
We have performed primary repair of bilateral cleft lip and nose on 169 patients in the past 15 years. During the first eight years, we used a small triangular flap skin design for the lip and for the nose correction, we used a corrective nasal cartilage lifting suture through rim incisions in order to bring the nasal dome cartilage toward the center and create the columella. The small triangular flap at the columella base was rotated 908 posteriorly to emphasize the contour of the nasolabial angle. In the subsequent 7-year period, the lip design was changed to the straight line method, and an inverted trapezoid suture was placed between the alar and nasal dorsum at four points. By this procedure displaced cartilages are moved into correct position and the alar groove became more distinct.
Archives of plastic surgery, 2012
This article presents long-term outcomes after correcting secondary bilateral cleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combination with a composite graft in order to elongate the short columella. A total of forty-six patients underwent surgery between September 1996 and December 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-U incision and V-Y plasty were used in 24 patients. A composite graft from the helical root was combined with a bilateral reverse-U incision in the 22 patients who possessed a severely shortened columella. The follow-up period ranged between 2 and 10 years. A total of 32 patients out of 46 were evaluated postoperatively. The average columella length was significantly improved from an average of 3.7 mm preoperatively to 8.5 mm postoperatively. The average ratio of the columella height to the alar base width was 0.18 preoperatively and 0.29 postoperatively. The postoperative basal and ...
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.
Indian Journal of Plastic Surgery
Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle. Aims: We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity. Settings and Design: This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty. Subjects and Methods: The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a sc...
Long-Term Comparison of the Results of Four Techniques Used for Bilateral Cleft Nose Repair
Plastic and Reconstructive Surgery, 2014
B ilateral cleft lip nose reconstruction is more challenging than unilateral cleft lip nose reconstruction. The midline structure is deficient in patients with bilateral complete cleft lip, characterized by a small prolabium, small premaxilla with deficient columella, and deformed lower lateral cartilage. 1 In our previous study, overcorrection on the cleft side nostril in patients with unilateral complete cleft lip produced the best surgical results. 2 The effect of overcorrection of both nostrils in patients with bilateral complete cleft lip has not previously been addressed in the literature. Two-stage reconstructions with the banked forked flap were once popular in our institution for the management of bilateral cleft lip nose deformity. Elongation of the columella was performed at age 1 to 6 years by advancing nasal floor tissue onto the columella and repositioning the alar cartilage. When the nasal floor tissues were inadequate, the elongation was performed using a composite auricular graft. In our experience, regardless of which methods were used, the scars were unsightly (compounded by the effect of scar contracture at this age) and the nostrils appeared unnatural (Fig. 1).
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.