Long-term evaluation of elongating columella using conchal composite graft in bilateral secondary cleft lip and nose deformity.
BACKGROUND
A short columella is one of the most severe problems in bilateral cleft lip and nose deformity. In particular, with tissue insufficiency or scar contracture on the upper lip, it is very hard to achieve a good nasal profile with conventional methods.


METHODS
One hundred thirty-seven patients with a short columella were operated on from February of 1987 to December of 2008. The average age at operation was 7.3 years. The conchal cartilage was harvested. The preauricular or postauricular skin-subcutaneous fat composite tissue was harvested. Through a transcolumellar incision, the conchal cartilage was inset and the defect was covered with skin-fat composite tissue. The serial nasal profiles were evaluated before and after surgery. Also, the postoperative nasal profiles were compared with normal profiles. The postoperative color difference with surrounding skin was measured by the L*a*b* photographic analysis method.


RESULTS
The mean height and width of skin-subcutaneous fat composite tissue were 9.81 and 22.14 mm, respectively. The preoperative and postoperative measuring for columella height was 5.1 + or - 1.1 mm and 14.2 + or - 1.5 mm. The columella-lip angle was 120.30 + or - 12.97 preoperatively degrees and 98.76 + or - 10.98 degrees postoperatively, whereas the angle of columellar-alar triangle was 111.56 + or - 11.39 degrees and 97.91 + or - 11.49 degrees, respectively. None of the postoperative profiles were different from those of normal Korean people of the same age except in the 0- to 6-year-old group (p < 0.05). The color match was best with preauricular composite tissue. Complications included total necrosis in three cases and partial necrosis in 12 cases that were treated conservatively.


CONCLUSIONS
Elongating columella using a composite graft can be a satisfying alternative, especially for a severe short columella with upper lip tissue deficiency.
Cheon
Young Woo
YW
Seoul, Korea From the Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, and the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine.
Park
Beyoung Yun
BY
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery; D000273:Adipose Tissue / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D055171:Nasal Cartilages / Q000002:abnormalities / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D023822:Tissue Engineering; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome