Seven fundamental procedures for definitive correction of unilateral secondary cleft lip nasal deformity in soft tissue aspects

Comparison of two different secondary rhinoplasties in patients with complete unilateral cleft lip and palate

BACKGROUND

The purpose of this study was to analysis the nostril symmetry and nasal stability following secondary rhinoplasty performed with either nasal septal cartilage implantation (G1) or simple alar cartilage suspension and internal fixation (G2) in patients with unilateral secondary cleft nasal deformity.

METHODS

Nostril and alar symmetry were analyzed retrospectively in 13 consecutive patients in G1 and 17 in G2. Assessment of three indexes was first performed using photogrammetric measurements of photographs at pre-operation(T1), 7 days after repair (T2), and at least 6 months after repair (T3). The ratio of the cleft side to the noncleft side for nostril width, nostril height and alar height were used to assess symmetry. Changes in the mean ratios of the cleft side to the noncleft side at three different time points for three parameters were used to assess stability.

RESULTS

In both groups, the alar height was improved after operation and remained stable in the follow-up period. The nostril width significantly decreased in G1 and G2, remaining consistent in the follow-up for G1 but increasing in G2. The nostril height significantly increased in G1 and stabilized during the follow-up, while it decreased after operation and remained so throughout the follow-up for G2.

CONCLUSION

Both techniques can maintain stability more than six months after surgery, except for the nostril width with simple alar cartilage suspension and internal fixation technique. The nasal septal cartilage implantation technique may have advantages in improving the nasal symmetry of the nostril width and height.

Primary Nasal Correction in Unilateral Cleft Lip: An Ongoing Journey

BACKGROUND

A cleft lip deformity, whether unilateral or bilateral, is usually associated with a deformity of the nose. In present day cleft surgery, it is routine to perform a varying extent of correction of the nasal deformity. There is often relapse and ongoing deformity which warrant further nasal surgery. The authors describe their method of nasal correction which includes using a hypodermic needle to help achieve repositioning and suspension of the nasal cartilages.

MATERIALS AND METHOD

The authors reviewed 100 consecutive cases of unilateral cleft lip who had nasal correction since June 2018. There were 59 males and 41 females with a mean age of 5.5 months. There were 72 complete and 28 incomplete cleft lips. The steps in nasal correction include septal repositioning, sutures to approximate the ala domes, and upper medial crura, suspension of the lower lateral cartilage to the upper lateral cartilage and sutures to approximate the skin, lower lateral cartilage, and mucosa in a sandwich fashion.

RESULTS

The patients were followed up for a range of 9 to 21 months with a mean of 18 months. The correction immediately postop and at 2 weeks follow up was good. However, at 1 year follow up there was some evidence of relapse. The correction achieved was, however, superior to that achieved before this method. None of the relapses were deemed severe enough to warrant further surgery at this stage.

CONCLUSIONS

This method of nasal correction is recommended to achieve superior outcomes in the surgical treatment of unilateral cleft lips.

Developing an Eye-Tracking Protocol to Determine Children’s Visual Perception of Secondary Cleft Lip Deformity

Objective:

To develop a protocol that will be used to measure children’s perception of secondary cleft lip deformity (SCLD) using objective eye-tracking technology.

Design:

Cross-sectional study. Data collection May and June of 2018.

Setting:

Single tertiary care pediatric hospital with a well-established cleft team.

Participants:

Participants were recruited from a general pediatric otolaryngology clinic. Sixty participants from 4 age groups (5-6, 10, 13, and 16 years) were enrolled on a voluntary basis.

Intervention:

Pediatric participants viewed images of children’s faces while wearing eye-tracking glasses. Ten images with unilateral SCLD and 2 control images with no facial scarring were viewed as gaze was assessed.

Main Outcome and Measure:

Successful gaze fixation was recorded across all age groups.

Results:

This article illustrates the types of data generated from glasses-based eye tracking in children. All children, regardless of age, spent more time with their gaze on a SCLD images (mean = 4.23 seconds; standard deviation [SD] = 1.41 seconds) compared to control images (mean = 3.97 seconds; SD = 1.42). Younger age groups spent less time looking at specific areas of interest in SCLD images.

Conclusion:

In this pilot study, we were able to successfully use eye-tracking technology in children to demonstrate gaze preference and a trend toward visual perception of SCLD changing with age. This protocol will allow for a future study, with larger and more diverse populations. Better understanding of how SCLD is perceived among children and adolescents has the potential to guide future interventions for SCLD and other facial deformities in pediatric patients.

Oronasal Transfixion Suture to Prevent Uplifted Nasal Floor Deformity in Cleft Lip and Palate Patients: A 5-Year Follow-Up

OBJECTIVE

In unilateral cleft lip and palate, the reconstructed nasal floor is sometimes uplifted regardless of the reconstructive method used. We used a 5-0 absorbable anchoring suture, the oronasal transfixion suture (ONT suture), to fasten the reconstructed nasal floor to the orbicularis oris muscle to prevent this deformity. This study was performed to evaluate the effects of the ONT suture.

DESIGN

Blind retrospective study of photography and chart review.

SETTING

Shinshu University Hospital, tertiary care, Nagano, Japan. Private practice.

PATIENTS

Ninety-three consecutive patients with unilateral complete cleft lip and palate who had undergone primary nasolabial repair in our department and affiliated hospitals between 1999 and 2011 participated in this study. Finally, 45 patients were included.

INTERVENTIONS

The ONT suture was put in place at the time of primary nasolabial repair.

MAIN OUTCOME MEASURE

The height of the nasal floor was evaluated on submental view photographs at 5 years old.

RESULTS

The ONT suture was applied in 21 patients. The height of the nasal floor on the cleft side was significantly closer to that on the noncleft side with the ONT suture than without the ONT suture ( P = .008).

CONCLUSIONS

The ONT suture is effective to prevent uplifted nasal floor deformity on the cleft side// in unilateral complete cleft lip and palate at the time of primary nasolabial repair.

Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.

Analysis of alar balance in secondary cleft lip with Z-plasty technique of nasal cartilage

The cleft nasal deformity is a prevailing problem of complex challenge for plastic surgery, especially in the secondary correction. We mainly chose 40 patients with unilateral secondary cleft lip nasal deformity with alar collapse. Based on biomechanics and anatomy of nasal cartilage, we adapt a Z-plasty with cartilage mucosa using the deformed lateral crus of the upper lateral cartilage to support the collapse of lower lateral cartilage. All of our patients were satisfied with the aesthetic morphology after surgery, so we are confident that this method should be considered as an auxiliary treatment to rhinoplasty.