Outcome analysis of a modified Tajima procedure

Correction of unilateral secondary cleft lip nose deformity by a modified Tajima's method and several adjunctive procedures based on severity

BACKGROUND

It is generally accepted that the developmental deficiency of the unilateral perinasal skeleton, cartilages, and skin originates from the secondary cleft nasal deformity. To date, numerous attempts have been made to correct these deformities, but no clinical data are available about the simpler, comprehensive, and patient-customized methods for correction of the secondary cleft nasal deformity. In the correction of Asian patients with secondary cleft nasal deformity, the clinical experience with the simplified Tajima method and several adjunctive procedures based on the severity of the disorder were retrospectively reviewed.

METHODS

During the period January 1982 to May 2009, 197 consecutive patients underwent repair through the modified Tajima method followed by several adjunctive procedures.

RESULTS

These series had no recurrence requiring surgery except for cases in which the nasal ala was depressed to some extent. The mean degree of patient satisfaction as rated on the 5-point Global Aesthetic Improvement Scale (GAIA) was 3.88 ± 0.59.

CONCLUSIONS

Various types of surgical procedures were performed using the modified Tajima method depending on the degree of alar cartilage displacement. These procedures were effective in achieving symmetry of the nasal tip for patients with secondary unilateral cleft lip.

Follow-up of unilateral cleft-lip nose deformity after secondary repair with a modified reverse-U method

Emphasis of secondary repair for unilateral cleft-lip has been placed on correction of the cleft-lip nasal deformity by translocation of the alar cartilage with its attached vestibular lining into a normal position, thereby establishing the normal vault and shape of the cartilage. We have managed cleft-lip deformities employing a modified reverse-U method. We present our modified technique and the obtained results. Eighty-nine patients with unilateral cleft-lip nasal deformity underwent surgical repair between 1998 and 2007 by one surgeon. These patients were divided into two groups based on their previous operative histories. Group A comprised 52 patients who underwent primary cheiloplasty using a modified Tajima technique. No other surgery had been performed prior to our modified reverse-U method in these cases. Group B consisted of 37 patients receiving the primary operation and/or more than one rhinoplasty at another hospital before our method was employed. The ages of our patients at the time of the secondary operation ranged from 4 to 40 years (average, 8.1 years; 4.2 years in group A and 13.4 years in group B). The follow-up period ranged from 2 to 11 years (average 7.2 years). For objective evaluation, points on the nasal dome and alar crease were measured on patient photographs. The results were retrospectively distinguished to three levels by total point score: Excellent, Good and Fair. Excellent or Good results were obtained in 74 cases, while 15 had Fair results. Eighty-one percent of all cases maintained acceptable results without relapse. Fair results were attributed to an unclear alar crease or relapse. In conclusion, rigid fixation and release of nasal cartilage are very important. We believe our modified reverse-U method to be very useful for achieving symmetry of the unilateral cleft-lip nose in the long term.

3-dimensional analyses of outcomes following secondary treatment of unilateral cleft lip nose deformity

OBJECTIVE

To analyze the 3-dimensional nasal forms after secondary treatment of unilateral cleft lip nose deformity.

PATIENTS AND METHODS

Thirteen Japanese adolescents with severe nose deformity associated with unilateral complete cleft lip with/without palate underwent definitive nose correction at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, and were followed for 1 to 3 years. Twenty healthy Japanese age-matched adolescents were included as controls. All patients were treated by open rhinoplasty through bilateral reverse-U incision and transcolumellar incision, correction of the columellar base with/without septoplasty, columellar strut graft, and medial-upward advancement of nasolabial components with vestibular expansion using a free mucosal graft. Pre- and postoperative nasal forms were measured using a 3-dimensional noncontact laser scanner. Angular and linear measurements, symmetry of the alar groove arch, and deviation of the nasal midline were analyzed.

RESULTS

Comparison of pre- with postoperative 3-dimensional nasal forms showed that postoperative nasal height was significantly increased (P < .01) but still shorter than that of controls. The significant preoperative differences in the nasal dorsal angle (P < .05) and bilateral alar groove arch (P < .01) disappeared after the operation. The deviation of the nasal midline was improved in the lower half of the nose (P < .05) postoperatively. There were no serious complications in any patients.

CONCLUSIONS

These surgical procedures can provide a symmetric and protruded nasal form, but there remain some differences between postoperative patients and healthy Japanese subjects.