Columella Lengthening in Bilateral Cleft Lip Nasal Deformity-Comparison of Five Different Methods

Abstract

Background: Patients with bilateral cleft lip often have nasal deformity. Controversy regarding primary versus secondary columella lengthening in terms of cosmetic outcome remain unsolved. Furthermore, there are few comparative studies to evaluate different methods for secondary columella lengthening. Aim and Objectives: The purpose of the study is to compare 5 different columella lengthening surgery (primary columella lengthening using island C-flap, the forked-flap method, composite graft, the Cronin's method, and open-tip V-Y rhinoplasty) in terms of the aesthetic result and revision rate. Materials and method: Within a period of 20 years, we retrospectively reviewed 146 patients with bilateral cleft nasal deformity undergoing columella lengthening surgery using one of the five above-mentioned techniques. The minimum follow-up period was 6 months and the patient age at final evaluation ranged from 4 years 8 months to 30 years. Aesthetic outcome was evaluated using 3 point scoring system as follows: 3 points indicating good result, 2 points indicating average result and 1 point indicating poor result. Thirty eight of all patients underwent repeated revisions; the primary aesthetic results of the 108 patients without revisions and the final aesthetic results of all 146 patients were recorded and mean scores were obtained for statistic analyses. Results: For aesthetic results, there was statistical significance among groups; the composite graft group had the worst aesthetic result with a mean score of 1.69 and open-tip V-Y rhinoplasty yielded the best results with a mean aesthetic score of 2.60. The rate of repeated revisions ranged from 5% (open-tip) to 52% (primary columella lengthening using island C-flap). For final aesthetic results, there was also statistical significance among groups; open-tip V-Y rhinoplasty was also superior in final aesthetic results (mean score=2.62) Conclusions: Because of its high revision rate, island C-flap primary columella lengthening is not recommended as a routine procedure for patients with bilateral cleft lip. As for the four secondary columella lengthening techniques used in our patients, open-tip rhinoplasty achieves best aesthetic result, has lowest rate of revision and should be considered as the option of choice.