New Flap from Non-Cleft to Cleft Side during Intermediate Rhinoplasty for Unilateral Cleft Lip Nasal Deformity | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 9, Volume 46, Issue 4, October 2022, Pages 381-387 PDF (18.51 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2022.269081 | ||
| Authors | ||
| Ali A Al Hazzab* 1; Helmy A Shalaby1; Ayman El Nemr2; Mohamed Khedr* 1 | ||
| 1The Department of Plastic & Reconstructive Surgery; Faculty of Medicine, Tanta University | ||
| 2The Department of Geral Surgery; Faculty of Medicine, Tanta University | ||
| Abstract | ||
| Background: Nasal distortion associated with a cleft lip < br />is known as cleft lip nasal deformity. Because of the asymmetry, the characteristics of unilateral and bilateral cleft lip nasal deformity differ. Surgical correction is staged based on the time of the surgery: Primary, intermediate, and secondary repair. We performed intermediate cleft rhinoplasty using a septum based adipofascial flap from non-cleft to cleft side of the nose as a new flap. Objectives: To reduce the tip asymmetry and maintaining new medial position of the corrected lower lateral cartilage. Patients and Methods: Twenty-one patients with unilateral cleft lip nasal deformity aged 4 to 12 years participated in this prospective study. They were treated with an intermediate cleft rhinoplasty that included a new flap technique. Subjective and objective assessments were performed before and after surgery. Results: The average ages were 7.5±2.9 years, with 16 males and 5 females, 17 left side and 4 right side clefts, and 15 patients with accompanied lip redo. A significant improvement achieved in one year post-operative subjective assessment score (p-value <0.001). There was a significant difference in comparing both sides Pronasale-Subnasale distance (Prn-Sn distance) pre-operative (p-value <0.01). After surgery by one month and one year, a non-significant difference in both sides Prn-Sn distance was noticed (p-value >0.1, >0.2 respectively). Conclusion: Intermediate cleft rhinoplasty provides more symmetrical nasal growth, which reduces the need for secondary rhinoplasty. It helps youngsters with unilateral cleft lip nose in their psycho-social issues. During intermediate cleft rhinoplasty, a new adipofascial flap was used to improve the tip symmetry and reduce the risk of relapse. | ||
| Keywords | ||
| Unilateral; Cleft; Nose; Intermediate; Rhinoplasty | ||
| References | ||
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1- Blair V. and Brown J.B.: Nasal abnormalities, fancied and real surgery. Gynecol. Obstet., 53: 797-819, 1931. 2- Allori A.C. and Mulliken J.B.: Evidence-based medicine: Secondary correction of cleft lip nasal deformity. Plast. Reconstr. Surg. 140 (1): 166e-76e, 2017. 3- Hoh E.Y. and Sulaiman W.A.: Analysis of pre-operative measurements in unilateral cleft lip patients toward the outcome of secondary cleft deformities. Cleft lip J. Palatecraniofac Anomal, 6 (2): 93-8, 2019. 4- Bonanthaya K. and Jalil J.: Management of the Nasal Deformity in the Unilateral cleft Lip and Nose, J. Maxillofac Oral Surg., 19 (3): 332-41, 2020. 5- Cuzalina A. and Jung C.: Rhinoplasty for the cleft lip and palate patient, Oral Maxillofac. Surg. Clin. North Am., 28 (2): 189-202, 2016. 6- Agarwal R. and Chandra R.: Alar web in cleft lip nose deformity: Study in adult unilateral clefts; J. Craniofac. Surg., 23 (5): 1349-54, 2012. 7- Berkowitz S.: (Ed.). Cleft lip and palate: Diagnosis and management. Springer Science & Business Media, p 315- 51, 2006. 8- Stebel A., Urbanova W., Klimova I., et al.: The Slavcleft: A three-center study of the outcome of treatment of cleft lip and palate. Nasolabial appearance, Peer J., 9 (4): e10631, 2021. 9- Guyuron B.: MOC-PS (SM) CME article: Late cleft lip nasal deformity. Plastic and Reconstructive Surgery, 121 (4): 1-11, 2008. 10- Gillies H. and Millard D.R.: The principles and art of plastic surgery. Boston, Little, Brown & Company, 1957. 11- Cronin T.D. and Denkler K.A.: Correction of the unilateral cleft lip nose, Plast. Reconstr. Surg., 82 (3): 419-32, 1988. 12- Aufricht G.: Presentation at the annual meeting of the American Society of maxillo-facial surgeons. Philadelphia, Pa., 1955. 13- Broadbent T.R. and Woolf R.M.: Cleft lip nasal deformity, Ann. Plast. Surg., 12 (3): 216-34, 1984. 14- Abdulrauf B.M.I.: The nasal cantilever technique in children undergoing primary cleft lip surgery: Novel concepts and review, Innov Surg Sci, 5 (1-2): 53-62, 2020. Quoted from McComb H. Treatment of the unilateral cleft lip nose, Plast. Reconstr. Surg., 55 (5): 596-601, 1975. 15- Sakamoto Y., Miyamoyo J. and Kishi K.: Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity, Plast Reconstr Surg Glob Open, 9 (4): e 3523, 2021. Quoted from McComb H.K., Coghlan B.A. Primary repair of the unilateral cleft lip nose: Completion of a longitudinal study. The Cleft palate-craniofacial journal, 33 (1): 23-31, 1996. 16- Kamel G.N., Segal R.M., Tsai C., et al.: How to Get Consistently Good Results in Cleft Lip Repair, Plast Reconstr Surg Glob Open, 9(7): e 3677, 2021. Quoted from Salyer K.E., Genecov E.R., Genecov D.G . Unilateral cleft lip-nose repair: A 33-year experience, J. Craniofac. Surg., 14 (4): 549-58, 2003. 17- Han K., Park J., Lee S. and Jeong W.: Personal technique for definite repair of complete unilateral cleft lip: Modified Millard technique, Arch. Craniofac. Surg., 19 (1): 3-12, 2018. Quoted from Anderl H., Hussl H., Ninkovic M. Primary simultaneous lip and nose repair in the unilateral cleft lip and palate, Plast. Reconstr. Surg., 121 (3): 959- 70, 2008. 18- Mancini L., Gibson T.L., Grayson B.H., et al.: Threedimensional soft tissue nasal changes after nasoalveolar molding and primary cheilorhinoplasty in infants with unilateral cleft lip and palate, Cleft Palate-Craniofacial J., 56 (1): 31-8, 2019. 19- Chaithanyaa N., Rai K.K., Shivakumar H.R. and Upasi A.: Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients. Journal of plastic, reconstructive & aesthetic surgery, 64 (1): 27-33, 2011. 20- Tiong W.H., Zain M.A.M. and Basiron N.H.: Augmentation rhinoplasty in cleft lip nasal deformity: Preliminary patients' perspective. Plastic Surgery International, 2014. 21- Ayeroff J.R., Volpicelli E.J., Mandelbaum R.S., et al.: Component restoration in the unilateral intermediate cleft tip rhinoplasty: Technique and long-term outcomes. Plast. Reconstr. Surg., 143 (3): 572e-80e, 2019. 22- Gosla-Reddy S., Nagy K., Mommaerts M.Y., et al.: Primary septoplasty in the repair of unilateral complete cleft lip and palate, Plast. Reconstr. Surg., 127 (2): 761-7, 2011 | ||
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