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Sohail M, Bashir MM, Bajwa MS, Farooq UK. Comparing definitive unilateral cleft rhinoplasty with and without diced-cartilage alar-base augmentation: A retrospective cohort study. J Craniomaxillofac Surg 2023:S1010-5182(23)00078-1. [PMID: 37353403 DOI: 10.1016/j.jcms.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/19/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023] Open
Abstract
This retrospective cohort study aimed to compare the long-term aesthetic outcomes and satisfaction of patients who underwent two techniques of definitive unilateral cleft rhinoplasty. The two cohorts, comprising patients with mature unilateral cleft deformity, were managed with definitive rhinoplasty, either with or without diced-cartilage alar-base and peri-alar augmentation (ABPA). Thirty patients were included in each cohort. Anthropometric measurements, complications, patient satisfaction scores, and third-party surgeon assessment scores were reviewed. In both cohorts, anthropometric parameters improved. Rhinoplasty with ABPA was the superior cohort in terms of columellar length (10.3 ± 1.0 in the cohort with ABPA, compared with 7.9 ± 0.6 in the cohort without ABPA; p < 0.001), alar-base angle (0.2 ± 0.2, compared with 4.3 ± 0.3; p < 0.001), and columellar deviation (2.5 ± 1.4, compared with 10.3 ± 2.1; p < 0.001). This cohort also had more symmetry in nostril height and nostril width (p < 0.001), a lower recurrence rate (one case compared with 22 cases; p < 0.001), a higher patient satisfaction score (p = 0.002), and a higher surgeon assessment score (p < 0.001, Cronbach's alpha = 0.706, Kendall's coefficient of concordance = 0.787). Within the limitations of this study, it appears that the described technique for augmenting the alar-base and peri-alar maxillary area is manageable, and yields consistent long-term results.
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Affiliation(s)
- Muhammad Sohail
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan.
| | - Muhammad Mustehsan Bashir
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
| | - Mohammad Suleman Bajwa
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
| | - Usman Khalid Farooq
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
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Long-Term Outcome of Primary Rhinoplasty with Overcorrection in Patients with Unilateral Cleft Lip: Avoiding Intermediate Rhinoplasty. Plast Reconstr Surg 2023; 151:441e-451e. [PMID: 36730430 DOI: 10.1097/prs.0000000000009923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND No consensus exists regarding the timing or technique of rhinoplasty for correction of the unilateral cleft lip nose deformity, with few studies examining the long-term effects of a single technique. This study appraised the long-term outcomes of primary rhinoplasty using the Tajima technique for overcorrection in a cohort of patients with unilateral cleft lip nose deformity after attaining skeletal maturity. METHODS Consecutive nonsyndromic patients with unilateral cleft lip nose deformity ( n = 103) who underwent primary rhinoplasty with overcorrection by a single surgeon between 2000 and 2005 were reviewed. Patients with unilateral cleft lip and nasal deformity who underwent primary rhinoplasty (but with no overcorrection) ( n = 30) and noncleft individuals ( n = 27) were recruited for comparison. Outcomes were assessed through FACE-Q scales evaluating satisfaction with appearance of nose and nostrils (two scales) and computer-based objective photogrammetric analysis of nasal symmetry (nostril height, nostril width, nostril area, alar height, and alar width parameters). RESULTS Significant differences (all P < 0.001) were observed between the Tajima and non-Tajima groups for all but one photogrammetric nasal parameter (nostril area), with the Tajima group demonstrating closer mean values to the noncleft group. The Tajima and noncleft groups demonstrated no significant difference (all P > 0.05) for scores of FACE-Q nose and nostrils scales. CONCLUSION This study indicated that the patients who underwent primary rhinoplasty with overcorrection had improved results with no necessity for intermediate rhinoplasty, emphasizing that the procedure is an effective approach to correct the unilateral cleft nose deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Liu Y, Li C, Yao M, Tsauo C, Wu M, Shi B. Labial-Nasal Evaluation for Nasal Floor Reconstruction With the New Triangular Flap in Unilateral Cleft Lip Repair. Cleft Palate Craniofac J 2023; 60:168-178. [PMID: 34860596 DOI: 10.1177/10556656211063090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. (P < .05). In addition, statistical significance was detected in the 1-year postoperative columellar angle, alar width ratio, nostril width ratio, nostril height ratio, and nostril shape (cleft) (P < .05), showing more successful repair of the nose compared with the traditional repair. The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry.
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Affiliation(s)
- Yingmeng Liu
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Chenghao Li
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Meilin Yao
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Chialing Tsauo
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Min Wu
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Bing Shi
- West China School of Stomatology, 12530Sichuan University, Chengdu, People's Republic of China
- West China Stomatological Hospital, 12530Sichuan University, Chengdu, People's Republic of China
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Xu Y, Zeng N, Li J, Zheng Q, Shi B. Growth patterns of the nasolabial region following unilateral cleft lip primary repair. Front Pediatr 2023; 11:1136467. [PMID: 36994436 PMCID: PMC10040551 DOI: 10.3389/fped.2023.1136467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical correction is the optimal way of repairing a congenital cleft lip. Patients with this condition often undergo initial surgical treatment at an early age and achieve an acceptable outcome. However, their levels of satisfaction will decrease in later stages of life as facial growth and development will inevitably cause changes in long-term outcomes, especially in the nasolabial region. Therefore, it is important for surgeons to understand nasolabial development after primary treatment and tailor their surgical techniques appropriately. This review focuses on the growth patterns of the nasolabial region after primary repair, so as to provide references for operative strategy.
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Long-Term Effect of Intermediate Rhinoplasty in Unilateral Complete Cleft Lip Nasal Deformity. J Craniofac Surg 2022; 33:2567-2572. [DOI: 10.1097/scs.0000000000008819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
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Correction of Severe Secondary Cleft Lip Nasal Deformity. J Craniofac Surg 2022; 33:404-408. [DOI: 10.1097/scs.0000000000008311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Component Restoration in the Bilateral Intermediate Cleft Tip Rhinoplasty. Plast Reconstr Surg 2021; 148:243e-247e. [PMID: 34398093 DOI: 10.1097/prs.0000000000008197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.
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Cho BC, Lee JW, Lee JS, Lee JH, Ryu JY, Tian L, Choi KY, Yang JD, Chung HY. Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision. J Plast Reconstr Aesthet Surg 2020; 74:1077-1086. [PMID: 33281085 DOI: 10.1016/j.bjps.2020.10.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Both LLCs were isolated, repositioned, approximated medially, and advanced with a Medpor strut, followed by tip suture technique. To further project and enhance the nasal tip and columella, application of ear cartilage onlay graft was used. As adjunctive procedures, septoplasty or osteotomy was carried out for correction of septal or nasal bone deviations, respectively. Photogrammetric evaluations of patients and statistical analyses were performed. Average age at operation was 23.5 years (range: 18-42 years). Of the 62 patients, 15 underwent dorsal augmentation with silicone implant. Two-layer conchal cartilage onlay grafting was performed to manage tip height. Outcomes in 34 patients were analyzed with pre- and postoperative photography. Nasal tip projection increased, alar base width index decreased, and alar and columellar symmetry significantly improved. No Medpor implant exposure or other adverse outcomes occurred. The proposed technique is effective for correcting secondary unilateral CLND and achieving a satisfying nasal appearance in adults.
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Affiliation(s)
- Byung Chae Cho
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Jeong Woo Lee
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Joon Seok Lee
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Jong Ho Lee
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Jeong Yeop Ryu
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Lulu Tian
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Kang Young Choi
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Jung Dug Yang
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
| | - Ho Yun Chung
- Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea.
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Establishment of New Asymmetrical Grafts in Secondary Nasal Deformity Repair. Plast Reconstr Surg 2020; 144:938e-939e. [PMID: 31425424 DOI: 10.1097/prs.0000000000006128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes. Plast Reconstr Surg 2020; 145:447e. [DOI: 10.1097/prs.0000000000006432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reply: Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes. Plast Reconstr Surg 2020; 145:447e-448e. [DOI: 10.1097/prs.0000000000006433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes. Plast Reconstr Surg 2019; 145:208e-209e. [PMID: 31834232 DOI: 10.1097/prs.0000000000006349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reply: Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes. Plast Reconstr Surg 2019; 145:209e-210e. [PMID: 31834230 DOI: 10.1097/prs.0000000000006350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reply: Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes. Plast Reconstr Surg 2019; 144:939e-940e. [PMID: 31403561 DOI: 10.1097/prs.0000000000006129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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