Histological comparison of the alar nasal cartilages in unilateral cleft lip

Double Composite Tissue Z-plasty Technique for Anatomical Restoration of Severe Nasal Deformity in Secondary Unilateral Cleft Lip

BACKGROUND

Patients with secondary unilateral cleft lip are regularly affected by serious nasal deformities especially of the alar and nasal floor. A large number of techniques for correction have been published, but symmetrical restoration of severe nasal deformation is difficult to achieve. We propose an innovative approach for anatomical restoration for this entity of nasal deformities to achieve long-term symmetrical appearance and muscular function.

METHODS

A total of 68 patients with severe nasal deformity due to secondary unilateral cleft lip underwent reconstructive surgery using a double composite tissue Z-plasty technique for anatomical restoration of cartilage, muscle, and soft tissue layers. Patient pictures were taken preoperatively and postoperatively to evaluate appearance and incisional wound healing. The surgical outcome was assessed based on a postoperative patient satisfaction survey. All occurring adverse effects were recorded.

RESULTS

All patients were followed up for at least 7 months up to 8 years; mean follow-up period was 14.6 months. Patients were highly satisfied with the aesthetic result and improved facial profile (97.1%) and healing of the incision site (94.1%). There were 4 cases of implant deviation and 2 cases of impaired ventilation due to hypertrophic scarring of the upper lip (2 patients) and relatively decreased nostril size after augmentation rhinoplasty (1 patient), respectively, requiring surgical revision 1 year postoperatively. No other complications such as bleeding, infection, flap necrosis, and sensory dysfunction were recorded.

CONCLUSIONS

The double composite tissue Z-plasty technique allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleft lip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patient satisfaction and acceptance.

Objective tools to analyze the lower lateral cartilage in unilateral cleft lip nasal deformities

Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.