Addressing the Soft Tissue Element in Unilateral Cleft Lip Nasal Deformity

Document Type : Original Article

Authors

1 Otorhinolaryngology department, Faculty of Medicine, Beni-Suef University, Egypt

2 Otorhinolaryngology department, Faculty of Medicine, Cairo University, Egypt

Abstract

The goal of this study is to address the soft tissue element of this deformity (in addition to the essential skeletal element) and evaluate its value in the final outcome. Soft tissue element includes modifying the shape of the nostril by direct incisions and augmenting the nasal sill by composite grafts. The current study is a randomized controlled trial study performed. Twenty patients with unilateral cleft lip nasal deformity were included during the period from November 2016 to December 2018. Patients were recruited from Otorhinolaryngology outpatient clinics in Beni-Suef University Hospital and randomly allocated into two groups: group (A) included 10 patients underwent skeletal reconstruction only (standardized technique), while group (B) included 10 patients underwent, in addition to skeletal reconstruction, and soft tissue manipulation (the new technique). The results showed that there was no statistical difference between both groups regarding hemicolumellar length, hemitip height, alar width length and domal angel. Linear and angular measurements showed improvement in both groups without difference.  Subjectively, patient satisfaction and peer review showed no significant difference.

Keywords


  1.  Kim SK, Cha BH, Lee, KC, Park JM. Primary correction of unilateral cleft lip nasal deformity in Asian patients: anthropometric evaluation. Plastic and reconstructive surgery, 2004; 114(6): 1373-1381.
  2. Gubisch, W. The triple swing flap  technique to correct the asymmetry of unilateral cleft lip nose deformities. Scandinavian journal of plastic and reconstructive surgery and hand surgery, 1998; 32(3): 287-294.
  3. Agarwal R, Chandra R. The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts. Plastic and reconstructive surgery, 2007; 120(6): 1633-1640.
  4. Mazzola RF. Secondary unilateral cleft lip nose. External approach. Facial plastic surgery J. 1996; 12: 367- 78.
  5. Kim SK, Cha BH, Lee KC, Park JM. Primary correction of unilateral cleft lip nasal deformity in Asian patients: anthropometric evaluation. Plastic and reconstructive surgery, 2004; 114(6): 1373- 1381.
  6. Mccomb, HK, Coghlan BA. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study. The Cleft palate-craniofacial journal, 1996; 33(1): 23-31.
  7. Huempfner-Hierl H, Hemprich A, Hierl T. Results of a prospective anthropometric and functional study about aesthetics and nasal respiration after secondary rhinoplasty in cleft lip and palate patients. Journal of Craniofacial Surgery, 2009; 20(8): 1863-1875.
  8. Okawachi T, Nozoe E, Nishihara K, Nakamura N. 3-dimensional analyses of outcomes following secondary treatment of unilateral cleft lip nose deformity. Journal of Oral and Maxillofacial Surgery, 2011; 69(2): 322-332.
  9. Hens G, Picavet VA, Poorten VV, Schoenaers J, Jorissen M, Hellings PW.  High patient satisfaction after secondary rhinoplasty in cleft lip patients. In International forum of allergy & rhinology, 2011; 1(3): 167-172.
  10. Masuoka H, Kawai K, Morimoto N, Yamawaki S, Suzuki S. Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft- lip nasal deformities. Journal of plastic, reconstructive & aesthetic surgery, 2012; 65(7): 857-863.
  11. Pollet J. Three autogenous struts for nasal tip support. Plastic and reconstructive surgery, 1972; 49(5): 527-532.
  12. Falces E. Use of ear cartilage grafts for nasal tip reconstruction. Plast Reconstr Surg.1972; 50:147-52.
  13. Thomson HG. (1985). The residual unilateral cleft lip nasal deformity: a three-phase correction technique. Plastic and reconstructive surgery, 1985; 76(1): 36-43.
  14. Matsuo K, Hirose T. Secondary correction of the unilateral cleft lip nose using a conchal composite graft. Plastic and reconstructive surgery, 1990; 86(5): 991-995.
  15. Ayhan M, Gorgu M, Erdogan B, Aytug Z, Aksungur E, Sy O, Oztan Y. Various applications of chondrocutaneous composite grafts in secondary cleft lip nose patients. Journal of Craniofacial Surgery, 2006; 17(6): 1065-1071.
  16. Tajima SADAO, Maruyama MASARU. Reverse-U incision for secondary repair of cleft lip nose. Plastic and reconstructive surgery, 1977; 60(2): 256-261.
  17. Flores, RL, Sailon AM. A novel cleft rhinoplasty procedure combining an open rhinoplasty with the Dibbell and Tajima techniques: a 10-year review. Plastic and reconstructive surgery, 2009; 124(6): 2041-2047.
  18. Metz AS, Pfortner R, Schmeling C, Rieger G, Mohr C. Nasal Entrance Correction in Cleft Lip Repair. J Oral Maxillofac Surg.2015; 73: 2038e7.
  19. Haddock NT, McRae MH. Long-term effect of primary cleft rhinoplasty on secondary cleft rhinoplasty in patients with unilateral cleft lip–cleft palate. Plastic and reconstructive surgery, 2012; 129(3): 740-748.
  20.  Pitak-Arnnop P, Hemprich A, Dhanuthai K, Yildirim V, Pausch NC. Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting. Journal of Cranio-Maxillofacial Surgery, 2011; 39(5): 319-325.
  21. Gurley JM, Pilgram T, Perlyn CA, Marsh JL. Long-term outcome of autogenous rib graft nasal reconstruction. Plastic and reconstructive surgery, 2001; 108(7): 1895-1905.
  22. Kane AA, Pilgram TK, Moshiri M, Marsh JL. Long- term outcome of cleft lip nasal reconstruction in childhood. Plastic and reconstructive surgery, 2000; 105(5):1600-1608.
  23. Han S, Choi MS. Three-dimensional z-plasty in the correction of the unilateral cleft lip nasal deformity. The Cleft palate-craniofacial journal, 2001; 38(3): 264-267.