title: Alar base flap and suspending suture: a strategy to restore symmetry to the nasal alar contour in primary cleft-lip rhinoplasty.
abstract: OBJECTIVE
  Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. We describe the mechanism and contribution of different surgical techniques to restore alar symmetry in primary cleft-lip rhinoplasty.
  
  
  METHODS
  We evaluate surgical results using a retrospective, randomized, blinded surgical grading system. We describe a surgical technique designed to restore nasal symmetry in patients undergoing primary cleft-lip rhinoplasty. Patients were selected retrospectively.
  
  
  METHODS
  A series of patients were identified with nasal asymmetry associated with cleft-lip deformity. All patients underwent cleft-lip repair with concurrent primary cleft-lip rhinoplasty. Patients who underwent alar base flap suspending suture (ABF-SS) were grouped and selected consecutively after a modification in the senior author's surgical technique. A control group was matched for age, sex, and cleft characteristics. Primary rhinoplasty was carried out concurrently for both study groups while undergoing unilateral cleft-lip repair. The control group did not undergo the described ABF-SS technique. All patients were operated on by the same surgeon over a period of 5 years. Surgical outcomes were evaluated by a panel including lay people as well as trained health care workers experienced in the critical evaluation of esthetic results after cleft-lip rhinoplasty.
  
  
  RESULTS
  Forty-six records were reviewed of patients undergoing complete unilateral cleft-lip repair. After applying strict inclusion/exclusion criteria, nine patients underwent the described ABF-SS technique. All patients in the preoperative group had a clinically and statistically comparable degree of deformity (P > .05). There was a clinical and statistically significant improvement in nostril size, shape, symmetry, alar base symmetry, and nasal tip/dome symmetry for patients undergoing repair with the described technique compared with the control group. No clinical or statistically significant difference was observed in the scarring scores between groups.
  
  
  CONCLUSIONS
  Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. Execution of the described surgical techniques restores nasal alar symmetry in patients undergoing concurrent primary cleft-lip rhinoplasty.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: William
authors.initials: W
authors.lastname: Numa
authors.forename: Kyle
authors.initials: K
authors.lastname: Eberlin
authors.forename: Usama S
authors.initials: US
authors.lastname: Hamdan
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome