The use of a cutaneous-muscular flap for primary naso-labial repair with a modified tennison-randall technique

Abstract

A cleft of the lip is almost always associated with a deformity of the nostril. Even if a highly successful primary repair of the lip is achieved, the nasal deformity usually remains and calls for treatment. The task is not an easy one, as is shown by the succession of new techniques that appear in the plastic surgical literature. In young children and in adults, correction of the nasal deformity is even more difficult. The outcome of any secondary rhinoplasty will be conditioned by the degree of existing deformities, which are the result of displacement of the maxillary segments and muscular asymmetry due to mal-alignment of the orbicularis muscle. The characteristic nostril deformity is all too familiar. On the affected side the alae are depressed or flattened out. The longitudinal axis of the nostril opening tends to become horizontal rather than vertically oblique. The anterior border of the medial crus is laterally displaced, baring the anterior border of the septum and distorting the columella. The floor of the nostril may be widened, narrowed or sunken. Whatever the degree and variety of the deformities, the outstanding morphological alteration is that of the nostril on the affected side. As Nishimura and Ogino (1977) point out, our main goal should be to produce symmetry of the nostrils. To achieve it we must correct first the alar cartilage, then the position of the alar base and finally the floor of the nostril. In our experience, it is feasible to correct primarily and simultaneously both the lip and the nose in children with unilateral cleft lip, even when they are referred for treatment at the age of g years and older. Using Tennison-Randall’s technique, we fashion a musculocutaneous flap from the outer border of the defect and advance it towards the corresponding hemicolumella. This provides adequate columellar support, restores a height equal to that of the columella on the unaffected side, raises the alar cartilage on the affected side, and so restores the symmetry of the nostrils.