Secondary Cleft Lip Nasal Deformity Research Articles

Comprehensive correction of secondary unilateral cleft lip nasal deformity using autologous cartilage and supported by septum cartilage

Objective To study the surgical method of comprehensive correction of secondary unilateral cleft lip nasal deformity using autologous cartilage and supported by septum cartilage and its outcomes. Methods Our surgery adopted an open approach, fully revealed the deformed alar cartilage and deviated nasal septum cartilage. Part of the nasal septum was removed and made it into various cartilage grafts to repair and reconstruct the columella, nasal tip, nasal alar and nasal dorsal by implanted in the corresponding positions. Results 18 patients with congenital unilateral cleft lip nasal deformity underwent the corrective and reconstructive surgery. The postoperative follow-up was 6-12 months, showing that the malformed nasal appearance came back to normal without obvious scar. The 18 patients did not have associated complications. Conclusions The surgery with a supplementary septal graft achieves good effect, the overall appearance of the malformed nose gets obvious changes, and therefore patients and their families are satisfied with the postoperative nasal shape. Key words: Nasal deformity; Nasal septal cartilage; Autologous cartilage; Cartilage transplantation

Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft

Secondary cleft lip nasal deformity is a complex deformity, and the variety of recommended techniques used to correct this deformity attests to it. Much of the nasal deformity can be attributed to an abnormal lower lateral cartilage. This study presents our experience with applying a lateral crural turnover flap with a sandwiched strut graft in adjunct with other procedures to correct unilateral secondary cleft lip nasal deformity. A retrospective review was conducted of 20 cases of unilateral cleft lip patients undergoing secondary rhinoplasty with lateral crural turnover flap with strut graft. Nostril base augmentation, columellar strut, suture techniques, and alar base reduction were performed as needed. Anthropometric analysis and subjective grading of the postoperative results were performed to evaluate the effect of the procedure on nostril symmetry. At long-term follow-up of 1 year, the symmetry for cleft side and noncleft side nostril height, width, and angulation of long axis of nostril improved after surgery. Subjective evaluation revealed improved results for all patients. The lateral crural turnover flap with sandwiched strut graft is a useful technique for reinforcing, repositioning, and reshaping the lower lateral cartilage in cleft lip patients with hyperconcave lateral crus and hypoplastic pyriform margin. Combined with other techniques, the nostril is increased in height, decreased in width, and thus satisfactory symmetry is obtained.

The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts.

To compare effects of secondary cleft procedures on alar base position and nostril morphology. Retrospective review. Multidisciplinary cleft clinic at tertiary center. Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base (P < .001), increased vertical lip dimension (P < .001), and decreased nostril height (P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support (P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view (P < .04). Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on superior border of bilateral nostril

Objective To introduce the method of lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril. Methods We adopted the method of using the skin cartilaginous tissue flaps on the superior border of bilateral nostril associated with alar cartilages reduction to lengthen the columella in 40 patients with severe secondary bilateral cleft lip nasal deformity. All patients were followed up for 5-28 months, with an average period of 15.3 months. The treatment outcomes were evaluated by a questionnaire in postoperative follow-up. Results All the 40 patients had achieved satisfactory lengthening of columella and there were no major complications. The questionnaire results showed 36 patients with excellent and 4 patients with good. Conclusions Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril is a relatively simple and safe method with good effect. Key words: Bilateral cleft lip; Nasal deformity; Nasal columella; Alar cartilage

The "Anatomical Balance Correction" for Secondary Cleft Lip Nasal Deformities.

Secondary cleft lip nasal deformities corrective procedures are still a major concern for the maxillofacial surgeons.

Diced cartilage under perichondrial carpet with reinforcement (DCUP) technique for nasal dorsal augmentation

Background: Correction of the secondary cleft lip nasal deformity is a real challenge for the esthetic surgeons. Grafts are an integral part of modern rhinoplasty with costal cartilage being increasingly used in the secondary case. The use of costal cartilage is fraught with problems like visibility and warping. Introduction: We propose an innovative alternative technique, Diced Cartilage Under perichondrial carpet with reinforcement (DCUP) technique keeping in mind, the Indian noses which usually do not support the liquid (filler) or semisolid (diced cartilage in fascia [DCF]) augmentation due to thick skin and weak structural support. Aims and Objective: To introduce a technique which can provide both a softer and natural looking dorsum and a strong framework to withstand the stress of healing forces in early postoperative period. Materials and Methods: Over the past 3 years we have used this technique in 25 patients with primary as well as secondary rhinoplasties including posttraumatic and secondary cleft lip nose deformity. Postoperative follow-up was done with clinical examination and photography. Results: In our study, a total of 25 patients were operated, there were 9 males and 16 females, giving a male:female ratio of about 1:2. Mean follow-up was 18 months. All patients had rounded, well contoured, and smooth dorsum. There was no incidence of fracture, warping, visibility or extrusion of graft, or palpable or visible sutures. Conclusion: Proposed technique of Diced Cartilage Under Perichondrial carpet with reinforcement (DCUP) technique is a very good alternative especially in Indian setting to keep the good effects of DCF that is, smoother, softer, and natural looking dorsum and also able to withstand postoperative contracting forces owing to its stable base of costal cartilage graft.

Application of asymmetric butterfly incision combined with vestibular V-Y advance flap in repairing unilateral secondary cleft lip nasal deformity

To explore a new surgical method and its effect in repairing secondary nasal deformity of unilateral cleft lip. Sixty-two patients with secondary unilateral lip and nasal deformity were treated with asymmetric butterfly incision combined with vestibular V-Y advance flap, and the subjective and objective indicators after operation were observed. All incisions healed with primary healing and all cases were followed up for 3-12 months. Fifty-eight cases got symmetric nostril and alar, the sum of absolute value of the nostril differences between both sides < 3 mm. Two cases got symmetric nostril and alar, but the sum of absolute value of the nostril differences between both sides was 3.5 mm and 4.2 mm respectively. The alar relapsed again in 2 cases and the results were not satisfied, the sum of absolute value of the nostril differences between both sides > 5 mm. The method of using the asymmetric butterfly incision combined with vestibular V-Y mucosa flap can reset the skin,cartilages and mucosa to the anatomic position effectively.

Analysis of alar balance in secondary cleft lip with Z-plasty technique of nasal cartilage.

The cleft nasal deformity is a prevailing problem of complex challenge for plastic surgery, especially in the secondary correction. We mainly chose 40 patients with unilateral secondary cleft lip nasal deformity with alar collapse. Based on biomechanics and anatomy of nasal cartilage, we adapt a Z-plasty with cartilage mucosa using the deformed lateral crus of the upper lateral cartilage to support the collapse of lower lateral cartilage. All of our patients were satisfied with the aesthetic morphology after surgery, so we are confident that this method should be considered as an auxiliary treatment to rhinoplasty.

Evaluation of the use of auricular composite graft for secondary unilateral cleft lip nasal alar deformity repair.

The purpose of this study is to evaluate the surgical outcome after using composite grafts for secondary cleft lip nasal deformities. A retrospective cohort study of one surgeon's outcome of 35 consecutive performed secondary cleft lip nasal deformity repair. Thirty-five patients with secondary nose deformity related to unsatisfactory cleft lip repair were operated using the proposed surgical technique since 2008. All these patients met the study criterion of having anthropometric measurements performed at least one year postoperatively. Measurement of nostril size was performed at the right and left side of the nose, preoperatively and at least one year postoperatively. The study found statistically significant differences between the preoperatory and postoperatory nose measurements. In addition, we have not found statistically significant differences between the cleft and noncleft nostril sizes measured at least one year postoperatively. The findings suggest that the proposed technique is a good alternative to address secondary nose deformity related to cleft lip primary repair.

Correction of secondary unilateral cleft lip nasal deformity by anatomical restoration and cartilage of nasal septum

Objective To explore the clinical methodology and effects of correction of secondary unilateral cleft lip nasaldeformity by anatomical restoration and cartilage of nasal septum.Methods With the Goodman's incision in the columella and nasal vestibule,we cut out the cartilage of nasal septum and built a new support structure of tip to reshape the nasal shape after the adequate anatomical restoration under the magnifier of 2.5 times.Results The operation corrected alanasi collapse skewed columella and nostrils symmetry,etc.21 cases were treated and followed up for a month and fifteen months,showing stablized effect with columella centerno alanasi collapse,symmetric nostril and no recurrence.Conclusions On the base of nasal anatomy,a good therapeutic effect has been archeived by the adequate anatomical restoration,cutting out the cartilage of nasal septum and builting a new support structure of tip to reshape the nasal shape. Key words: Cartilage of nasal septum; Anatomical restoration; Secondary unilateral cleft lip nasa deformity

Evidence-based medicine: The cleft lip nasal deformity.

After studying this article, the participant should be able to: (1) Describe the components of unilateral and bilateral secondary cleft lip nasal deformity. (2) Discuss current methods of assessing the deformity and outcomes. (3) Discuss primary treatment options including the use of preoperative orthopedics, nasal molding techniques, and the primary cleft rhinoplasty. (4) Design a treatment plan for cleft patients that will optimize the outcome of nasal appearance and function. (5) Discuss the evidence regarding outcomes of current practices, and describe areas where more research is needed. This is the third Maintenance of Certification article on the secondary cleft lip nose deformity. In the first article, Guyuron defined the deformities and described techniques for the definitive (adult) rhinoplasty. The second article, by Zbar and Canady, presented evidence regarding the assessment, surgical treatment, and outcomes from the literature published between 1999 and 2009. In this article, the authors summarize important points from the first two articles and then concentrate on the evidence for the following topics: (1) methods currently used in evaluating the severity of the deformities; (2) methods used in evaluating outcomes of different treatments; (3) benefits of rhinoplasty performed at the time of the lip repair and evidence for the effect of rhinoplasties performed after infancy but before maturity; (4) presurgical orthopedics and nasoalveolar molding; (5) common surgical techniques used in primary cleft rhinoplasties; and (6) impact of the nasal deformity on quality of life. Overall, there is little high-level evidence regarding the outcomes of cleft nasal deformity treatment, leaving much room for future study.

Application of autologous costicartilage trestle in correction of secondary cleft lip nasal deformity

Objective To use autologous costicartilage trestle to correct secondary cleft lip nasal deformity,in order to obtain a nice nose.Methods A total of 64 patients were treated,including 51 unilateral and 13 bilateral cleft lip,aged 16 to 38 years,with the average of 21 years.The deformity included cripetura columellar,flattened nasal tip,anisopleural nostril and caved nosewing.The carven costicartilage was embedded into bilateral nasal septum to form a new trestle for remodelling the shape of nose and nasal tip.Results The follow-up time was 3 months to 2 years,showing that all patients were satisfied with the outline of external nose,without infection and costicartilage revealed.Conclusions The autologous costicartilage is easy to collect without rejection reaction,and therefore it can be used in correcting secondary cleft lip nasal deformity with fair improvement of nasal outline,especially in nasal tip height. Key words: Cleft lip; Nasal deformity; Autologous costicartilage trestle

The Correction of a Secondary Bilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

BackgroundThis 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.MethodsA 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.ResultsA 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 lateral views revealed a better shape of the nostrils and columella. The elongated columella, combined with a composite graft, presented good maintenance of the corrected position with no growth disturbance. A composite graft showed color mismatching in several patients. Twenty-six patients demonstrated no alar-columella web deformity and satisfactory symmetry of the nostrils. Four patients experienced a drooping and overhanging of the corrected alar-columella web.ConclusionsA bilateral reverse-U incision with V-Y plasty or in combination with a composite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

Seven Fundamental Procedures for Definitive Correction of Unilateral Secondary Cleft Lip Nasal Deformity in Soft Tissue Aspects

It is accepted that patients who undergo appropriate primary repair for cleft lip will have secondary deformities. Because these deformities are caused by complex and diverse patterns, the deformities were categorized to provide a standardized treatment for each category. Pathologic characteristics of 1,170 patients were classified into 7 categories. Corrections were performed using 7 fundamental procedures corresponding to the surgical resolution of each deformity: 1) transposition of the caudal septum; 2) release of the septal-cartilaginous junction; 3) medial crus elevation; 4) lateral crus elevation; 5) release of the orbicularis oris muscle from the lip elevators; 6) anchoring of the orbicularis oris muscle to the anterior nasal spine; and 7) philtral column formation. A satisfaction survey was performed to evaluate the overall outcomes in 171 patients and an anthropometric analysis was performed in 38 patients. Satisfactory scores obtained through postoperative follow-up were higher than preoperative scores, and there was no difference between postoperative scores obtained over the short and long term. All preoperative anthropometric measurements were different from the postoperative measurements, indicating that the fundamental procedure achieved effective outcomes. These proposed 7 fundamental procedures can be used as guidelines that can always be applied for the correction of any secondary cleft lip nasal deformity to obtain ideal treatment outcomes.

An Evidence-Based Approach to Secondary Cleft Lip Nasal Deformity

The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.

Subnasale Flap for Correction of Columella Base Deviation in Secondary Unilateral Cleft Lip Nasal Deformity

To present the effects of subnasale (SN) flap on the correction of deviated columella base in patients with secondary unilateral cleft lip nasal (UCLN) deformity. The patients were 6 adult Koreans with cleft cases (mean age, 29.1 y; range, 20-43 y; 1 man and 5 women; secondary UCLN deformity with columella base deviation). After the open rhinoplasty with the Padovan incision had been completed for correction of the secondary UCLN deformity, the SN flap was used for correction of the deviated columella base. The design of the SN flap started from the central portion of the SN region that will be the reconstructed columella and extended to the nasal floor in the larger nostril site. Then, the SN flap was transposed into the smaller nostril site. The columella skin was also elevated and placed into the larger nostril site with the distal end inserting into the donor site. The patients' follow-up period was 16 to 40 months. The SN flap after the open rhinoplasty with the Padovan incision resulted in minimal scarring on the donor and recipient sites. The deviated columella base was straightened in all cases. During the surgical follow-up period, there was no recurrence of the columella base deviation in any patient and no other noteworthy complications were found. For correction of the columella base deviation in patients with secondary UCLN deformity, the SN flap can be a viable treatment option.

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

ABSTRACTThe treatment of patients with unilateral cleft lip has undergone significant 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 significant functional and aesthetic improvement; seven patients (13.07%) had significant aesthetic improvement but a modest functional improvement; and five patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that five out of seven patients in the second group had pharyngeal flaps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these flaps 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 specific functional and aesthetic needs.

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

The treatment of patients with unilateral cleft lip has undergone significant 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 significant functional and aesthetic improvement; seven patients (13.07%) had significant aesthetic improvement but a modest functional improvement; and five patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that five out of seven patients in the second group had pharyngeal flaps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these flaps 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 specific functional and aesthetic needs.

Correction of Severe Secondary Cleft Lip Nasal Deformity Using a Composite Graft: Current Approach and Review

In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.

Major Hematological Diseases Associated With Cleft Lip and Palate

Abstract Objective: Cleft lip and palate is among the most common congenital anomalies. Its association with major blood disorders has rarely been reported. The purpose of this study was to report two patients who had major blood diseases associated with cleft lip and palate. Patients and Results: From June 1995 to December 1997, there were 2700 patients with cleft lip, cleft palate, or both who received treatment at Chang Gung Memorial Hospital. Two of them were found to have major hematological disorders. In both cases, the disorder was detected by preoperative blood cell counts and white cell differentiation. Case 1 was a 21-year-old woman patient with repaired right cleft lip. She was admitted for alveolar bone grafting and closure of oronasal fistula. Abnormal presentation of blast cells was found, and subsequent bone marrow study confirmed acute lymphocytic leukemia. Case 2 was a 26-year-old man with left secondary cleft lip nasal deformity scheduled to receive staged reconstructive operations. An e...