Surgical technique for secondary correction of unilateral cleft lip-nose deformity: clinical and 3-dimensional observations of preoperative and postoperative nasal forms.
OBJECTIVE
Despite recent developments in cleft surgery, a surgical method for secondary correction of unilateral cleft lip-nose deformity has not yet been established. The purpose of this study was to describe the surgical techniques for secondary correction of unilateral cleft lip-nose deformity with 3-dimensional (3D) observations of preoperative and postoperative nasal forms.


METHODS
Secondary corrections of unilateral cleft lip-nose deformity were performed on 13 patients with a complete unilateral cleft lip and palate, and these patients were followed up for 1 year to more than 3 years. All patients were treated by open rhinoplasty through a bilateral reverse-U incision and transcolumellar incision, correction of the columella base with/without septoplasty, nasal tip cartilage graft, and medial-upward advancement of nasolabial components with vestibular expansion by free mucosal graft. Preoperative and postoperative nasal forms were observed by use of photos and 3D data obtained serially.


RESULTS
The postoperative nasal forms were improved in all patients. The preoperative 3D color images indicated asymmetry of the alar groove and nasal tip visually. The top of the alar groove on the cleft side was dislocated distally and downwardly, resulting in a small snub ala. The postoperative 3D color images showed symmetric nasal forms with the adequately recovered nasal tip projection and the appropriate circle of the nasal ala groove on the cleft side. There were no serious postoperative complications.


CONCLUSIONS
Repositioning of the nasalis muscle and sufficient expansion of the nasal vestibule as well as reconstruction of nasal cartilages are important for correction of unilateral cleft lip-nose deformity.
Nakamura
Norifumi
N
Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. nakamura@denta.hal.kagoshima-u.ac.jp
Okawachi
Takako
T
Nishihara
Kazuhide
K
Hirahara
Narihiro
N
Nozoe
Etsuro
E
D000293:Adolescent; D000328:Adult; D002971:Cleft Lip / Q000150:complications*; D002972:Cleft Palate / Q000150:complications*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D007834:Lasers; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery; D009297:Nasal Mucosa / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000002:abnormalities* / Q000601:surgery*; D010781:Photography; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult