Primary cleft nasal repair: the composite V-Y flap with extended mucosal tab

Primary Cleft Rhinoplasty with Custom Suture Needle for Alar Cartilage Repositioning in Unilateral Cleft Lip Patients: 3D Nasal Analysis

OBJECTIVE

Primary nasal correction has been demonstrated to be a beneficial practice for patients with unilateral cleft lip and palate. However, there is currently no consensus among cleft surgeons regarding the ideal approach to addressing the malpositioned cartilages. This study aims to introduce a new surgical technique for repositioning deformed lower lateral cartilage during primary cleft rhinoplasty, which involves using a customized suture needle.

DESIGN

Retrospective cohort study.

SETTING

Tertiary university-affiliated hospital.

PARTICIPANTS

This retrospective study included 51 patients with unilateral cleft lip and palate who underwent primary rhinoplasty during the labial repair.

MAIN OUTCOME MEASURES

A morphological analysis of the nose was conducted using three-dimensional (3D) photographs. The cleft-to-noncleft side ratios of various nasal parameters, including nasal tip volume, nostril width, height, and area, were calculated at three time points: preoperative (T0), 3 months postoperative (T1), and 1 year postoperative (T2).

RESULTS

Significant improvement (p < 0.05) was observed in the cleft-to-noncleft side ratios of nasal volume and nostril parameters. The nasal volume ratio and nostril height ratio remained stable, with no significant differences between the T1 and T2 periods. The nostril width ratio increased from 0.96 ± 0.13 at T1 to 1.05 ± 0.16 at T2, indicating an appropriate degree of surgical overcorrection of nasal width during primary lip repair.

CONCLUSION

Primary cleft rhinoplasty using a Chang's needle allows direct suture placement in the intercartilaginous region with minimally invasive approach, thereby preserving growth potential of the nose and restoring the nasal symmetry.

Primary Cleft Rhinoplasty: Surgical Outcomes and Complications Using Three Techniques for Unilateral Cleft Lip Nose Repair

BACKGROUND

This study represents a single surgeon's 10 years of experience addressing unilateral cleft lip and palate nose deformity. The purpose was to compare surgical outcomes and related complications using 3 different techniques to improve nasal shape in primary unilateral cleft rhinoplasty.

METHODS

This retrospective study with Institutional Ethical Committee approval compares 3 groups of patients with unilateral cleft lip nose and palate who were operated on using different techniques from 2007 to 2017. Surgical outcomes were analyzed by physical examination at least 1 year after primary rhinoplasty. Anthropometric measurements were obtained for the cleft and noncleft sides of the nose.

RESULTS

Approach with general analysis indicated differences among the 3 techniques. The author's comparative study revealed differences in nose symmetry and related complications, including increased recurrence of nose deformity using the modified McComb technique. Better short-term nose symmetry was observed using Potter technique and the V-Y-Z rhinoplasty.

CONCLUSIONS

Potter approach and the V-Y-Z techniques achieve better short-term nose symmetry than the McComb method. Complications were less common in the group of patients operated on using the modified McComb technique. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty using the proposed methods.

A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique

Background:

This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair.

Materials and Methods:

This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded.

Results:

There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty.

Conclusions:

We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.

Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty: An anthropometric study

Background:

Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities.

Methods:

A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively.

Results:

Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively.

Conclusions:

The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip.

Correction of unilateral cleft lip nasal deformity in preschool and school-aged children with refined reverse-U incision and V-Y plasty: long-term follow-up results

BACKGROUND

A total of 47 preschool and school-aged patients with cleft lip nasal deformities underwent surgery between September of 1996 and December of 2003. The age of the patients ranged from 4 to 10 years.

METHODS

A reverse-U incision and V-Y plasty were used in 40 patients with mild to moderate unilateral cleft lip deformities. An open rhinoplasty incision combined with a reverse-U incision and V-Y plasty was used in seven patients with severe unilateral cleft lip nasal deformities. The follow-up period ranged from 6 months to 9 years, with an average of 4 years.

RESULTS

The final results were evaluated on the basis of the degree of symmetry of both nostrils. The length of the longitudinal axis of the nostril and width at the midcolumella level were measured with calipers. Excellent results were obtained in 28 patients in whom alar-columella web deformities were absent or minimal, and a satisfactory symmetry of the nostrils was obtained. Thirteen patients showed good results, four patients showed fair results, and two patients showed poor results. Postoperative nostril symmetry was maintained within 1 to 2 years of follow-up. However, there was a mild change of the corrected alar-columella web 4 to 5 years after the operation.

CONCLUSIONS

These results suggest that the reverse-U incision and V-Y plasty are useful methods for creating symmetry of the nostrils in cases of cleft lip nasal deformities. In addition, they are recommended for a slight overcorrection of the cleft lip nasal deformity in preschool and school-aged children.