title: A modified V-Y chondromucosal composite flap for correction of secondary cleft nasal deformity: photogrammetric analysis of a case-control study.
abstract: BACKGROUND
  Secondary cleft nasal deformity is a combination of the inherent cleft defects and the effects of operations to address the primary nasal deformity. The authors revisited a modified V-Y chondromucosal flap to restore symmetric nostril shape and balanced tip projection.
  
  
  METHODS
  A retrospective case-control study of the senior author's (J.A.T.) experience with secondary cleft tip rhinoplasty using the V-Y chondromucosal flap was conducted. Preoperative and postoperative anteroposterior and worm's-eye photographs were compared by means of photogrammetric analysis. Results were compared with those of controls who had not undergone surgery. Interrater reliability was assessed using the Pearson coefficient.
  
  
  RESULTS
  Seventeen cases and 24 controls were reviewed. Average age at repair was 9.3±3.6 years; average follow-up was 13 months. Interrater reliability was 0.98 overall. Photogrammetric analysis demonstrated postoperative increases in cleft-side columella length by 2.3 mm (p=0.0001) and nasal apex height by 1.3 mm (p=0.003); non-cleft-side measurements were statistically unchanged. Control measurements were similar across 1-year visit interval, and when compared with cases, patients undergoing tip rhinoplasty had significantly different cleft-side columella length postoperatively (increase of 2.31 mm versus 0.15 mm; p=0.0002) and nasal apex height (increase of 1.29 mm versus 0.17 mm; p=0.03). All other parameters remained comparable. No complications and no external nasal valve collapse were observed.
  
  
  CONCLUSIONS
  In select patients, use of a V-Y chondromucosal flap increased cleft-side nasal tip projection and columellar height, improving overall nasal tip appearance. Although absolute width of the cleft alar base is unchanged, the cleft-side nostril is qualitatively more symmetric postoperatively.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia; and the Division of Plastic Surgery, Hospital of the University of Pennsylvania, The Children's Hospital of Philadelphia.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Wilson
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000637:transplantation; D009297:Nasal Mucosa / Q000637:transplantation; D010780:Photogrammetry; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps