title: Conchal Cartilage Graft for Correction of Bilateral Cleft Lip Nasal Deformities during Childhood.
abstract: BACKGROUND
  Various methods for primary repair of bilateral cleft lip have been developed, but they often produce inadequate results, such as an upturned nose or a short columella. We perform primary lip repair with muscle reconstruction to correct depression of the nasal floor and inferoposterior displacement of the alar base. Then, open rhinoplasty to project the nasal tip is performed during childhood. This article describes the methods and results of open rhinoplasty for bilateral cleft lip patients.
  
  
  METHODS
  Open rhinoplasty with a modified forked flap is performed. The harvested conchal cartilage is grafted as a strut to strengthen and extend the septum. The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position. Before skin closure, the tips of the 2 V flaps of the forked flap and the reverse V-flap between the forked flap are trimmed. Three trapezoidal flaps are sutured to the base of the columella. Thirty patients with bilateral cleft lip nasal deformities have undergone surgery. The operative results of 15 of 30 patients were evaluated photogrammetrically.
  
  
  RESULTS
  The nose was refined and more projected. The nasolabial angle and the nasal tip projection were improved. The reformed configuration was well maintained for many years. Photogrammetric analysis demonstrated increases in both the nasal height-to-width ratio and the nostril height-to-width ratio and a decrease in the nasolabial angle.
  
  
  CONCLUSIONS
  Open rhinoplasty during childhood using 3 trapezoidal flaps and conchal cartilage graft improves bilateral cleft lip nasal deformities effectively.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Masuoka
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Morimoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Yamawaki
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawazoe
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and Department of Plastic and Aesthetic Surgery, Yoshikawa Hospital, Kyoto, Japan.
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Suzuki