Columellar lengthening using the interdigitation of triangular flaps

The most common and striking feature of the bilateral cleft lip nose deformities is a short columella. This problem can be resolved by lengthening the columella. In this article the authors lengthen the columella using the interdigitation of triangular flaps in the upper lip tissue. The columellar elongation is made by an advancement of nostril tissue and an interdigitation of the triangular flaps. Our method shows good aesthetic results. The triangular flaps that are intersected without excision make the columellar base pyramidal and medially directs the alar bases, narrowing the width of the nostril sills. Though the optimal columellar lengthening procedure can vary according to the deformed anatomy of the nose and lip, this method deserves to be considered especially in patients who have sufficient tissue in their nostril sills.     

Aesthetic considerations related to repair of the bilateral cleft lip nasal deformity

A study of the changing configuration of the nose tip with age shows that the columella naturally takes a greater share of nose tip projection with increasing age. In the infant and small child, when most repairs are done, nose tip projection is due more to the alar dome component than to the columella. Over-lengthening the columella at the expense of alar dome projection results in an unaesthetic nose at maturity. The nasal correction should be towards a normal proportion for age and attention must be paid to alar dome configuration. Where the inferior view shows a "tent tip" skyline, lateral crus advancement is required and can be achieved in asynchronous repairs by Pigott alar leapfrog at primary repair or by Potter V-Y advancement at the time of forked flap columella lengthening. The profile view of the nose and lip shows that the lip "drops" from a point about two-thirds of the way from nostril apex to alar base. A key stitch advancing the alar bases at the time of columella lengthening allows the philtral area to bow forwards as a prow so that it comes to lie in a normal relationship with the columella in the profile view.     

Embryonic rationale for the primary correction of classical congenital clefts of the lip and palate.

Primary correction of congenital clefts of the lip and palate should be designed to carry the interrupted embryonic process to normal completion. This is best accomplished by maxillary alignment with presurgical orthodontics, stabilisation of the maxillary alignment, obliteration of the alveolar cleft and construction of the nasal floor with periosteoplasty. This allows early construction of the lip by rotation and advancement and correction of the nose with columella lengthening, alar cartilage positioning and alar base cinching. This can be accomplished before school age.     

复杂性鞍鼻的综合整形术

目的：探讨复杂性鞍鼻的综合整复方法。方法：采用鼻翼软骨重塑改善鼻端形态，人中推进皮瓣加长鼻小柱，硅胶假体充填降鼻，以及鼻翼沟埋线缝合塑形加强鼻端部轮廓等综合技术，对10例复杂性鞍鼻进行整复。结论：经3个月至2年的随访，所有患者鼻背隆起，鼻尖抬高，鼻小柱延长，形态稳定，效果满意。结论：该综合整复术对复杂性鞍鼻可以得到较好的效果，手术方法简单易行，创伤小，易推广。     

Columella Lengthening in Bilateral Cleft Lip Patients: Experience with the Forked Flap Procedure

All patients with bilateral complete clefts of the lip and some patients with incomplete clefts have a short or almost non-existing columella. This is a characteristic deformity which can only be corrected by surgical lengthening of the columella. Among the numerous methods which have been used for this purpose, the forked flap method as described by Millard (1958) has certain advantages: 1. Sufficient donor tissue is available in the lateral parts of the prolabium to produce full lengthening of the columella and adequate projection of the tip of the nose. 2. Most patients with bilateral clefts need secondary correction of the lip scars and a narrowing of the nostrils after the primary operation. Both of these objectives are achieved as a part of the forked flap procedure. 3. Access is gained both to the lip muscles and to the alar cartilages at the tip of the nose. 4. Narrowing of the lip in the upper part results in a natural eversion of the lower part, and a short lip can be lengthened by letting the remaining central part of the prolabium go down during suturing. 5. The scars left in the upper lip are in an unobtrusive position corresponding to the philtral ridges. During the period 1965-77, 87 patients with bilateral cleft lip have had a columella lengthening performed according to the forked flap method. Our experience with this method has been very favourable. No serious complications have ensued, and the cosmetic results have been most satisfactory in the majority of cases.     

开放式唇裂继发鼻畸形整形术

目的：探讨单侧唇裂继发鼻畸形的手术治疗。方法：应用跨鼻小柱的鼻翼软骨下缘切口开放式鼻整形进行唇裂继发鼻畸形矫正,鼻小柱侧缘切口继续向下延伸至鼻小柱基底,将鼻小柱基部皮肤向下翻开,充分松解和暴露鼻翼软骨,矫正中隔畸形,将鼻翼软骨向前上内侧复位,与健侧鼻翼软骨、鼻背侧软骨缝合固定,必要时进行切取鼻中隔软骨移植以抬高鼻尖以及加强鼻穹窿。结果：应用本方法治疗单侧唇裂继发鼻畸形47例,单纯进行鼻畸形矫正者11例,同时行唇畸形整形者36例,效果满意,其中有32例进行了6～24个月的随访,平均随访时间为11个月,鼻外形良好。结论：应用开放式鼻整形技术进行唇裂继发鼻畸形矫正,可在直视下充分松解并显露鼻翼软骨,准确复位及缝合固定,术后效果稳定,切口无明显瘢痕。     

单侧完全性唇裂术后继发鼻唇畸形的一次性修复

目的：介绍一种综合术式一次性整体矫正单侧完全性唇裂术后继发鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定，以缩窄以平齐鼻底；穹隆MT瓣成形术改善鼻孔形状；带侧翼鼻假体隆鼻突出鼻部立体感和加高鼻翼；上唇M瓣成形修整唇红缘重建唇弓；双侧口角为蒂的唇黏膜瓣或下唇瓦合式黏膜瓣修复上唇唇红过薄、过短或部分缺损。结果：单侧完全性唇裂术后继发鼻唇畸形21例，随访10例3个月至1年，外观和效果满意。结论：应用一针法鼻小柱鼻翼脚复位加MT成形术和双蒂唇黏膜瓣移植等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。     

Long-term outcome of simultaneous repair of bilateral cleft lip and nose (a 15 year experience).

We have performed primary repair of bilateral cleft lip and nose on 169 patients in the past 15 years. During the first eight years, we used a small triangular flap skin design for the lip and for the nose correction, we used a corrective nasal cartilage lifting suture through rim incisions in order to bring the nasal dome cartilage toward the center and create the columella. The small triangular flap at the columella base was rotated 90 degrees posteriorly to emphasize the contour of the nasolabial angle. In the subsequent 7-year period, the lip design was changed to the straight line method, and an inverted trapezoid suture was placed between the alar and nasal dorsum at four points. By this procedure displaced cartilages are moved into correct position and the alar groove became more distinct.Long-term observations showed a favorable configuration of the nose, and eliminated the bilateral cleft nose stigma with only minimum degree of growth disturbance. The remaining problem is the somewhat superior faced nasal tip. To leave the bilateral cleft lip nasal deformity uncorrected for a long period places great psychosocial burden on the patient and the family. We believe that it is desirable to conduct early lip and nose repair synchronously in a minimally invasive manner, as a collaborative effort between plastic surgeons with specialized training in cleft lip repair and an interdisciplinary team.     

Bilateral reverse U incisions and separately placed columella relaxation incision for correction of bilateral cleft lip nose deformity

The reverse U incision method has been employed for the correction of the unilateral cleft lip nose deformity for more than twenty years with satisfactory results. It has some columella lengthening effect and thus has proved to be useful for the correction of nasal deformities of bilateral cleft lip. To augment its columella lengthening effect a columella relaxation incision is added to the bilateral reverse U incision for the correction of the bilateral cleft lip nose deformity. This results in a reconstructed columella of satisfactory length and width.     

Alar Rotation Flap for Small Defects of the Ala

BACKGROUND: Surgical defects of the alar lobule can be difficult to repair with aesthetically pleasing results. Full-thickness skin grafts are often smoother than the sebaceous skin of the ala. Random patterned flaps from the cheek or proximal nose usually bridge and obliterate the supra-alar crease and may cause nasal valve malfunction. OBJECTIVE: We describe and illustrate a technique to repair subtotal alar lobule defects within the cosmetic unit of the alar lobule. METHODS: Twenty-three consecutive alar lobule rotation flaps for repair of Mohs surgical defects were reviewed by patient examination and interview. RESULTS: Twenty-one of 23 patients were contacted. Patients rated cosmetic results as excellent (18), good (2), or fair (1), and no patients graded their results as poor. Six patients reported "a little" breathing difficulty in the postoperative period that resolved within 6 months. Anesthesia reported by 11 of 21 patients resolved within 5 years in 8 of 9 patients available for follow-up. CONCLUSION: Rotation of the ala combined with cheek advancement is a cosmetically pleasing and functional method to repair deep defects of the ala.     

Reconstruction of columella, membranous septum, and upper lip in a single stage operation.

Reconstruction options for columellar defects together with membranous septum, nasal base, and upper lip are restricted. We present a case successfully treated with bilateral cheek advancement flaps with upper medial, perialar skin flaps to reconstruct the upper lip, columella, nasal base and membranous septum in a single session. This method provides adequate tissue with minimal cosmetic deformity in a single stage for repairing such compound defects.     

Para-alar crescentic subcutaneous pedicle flap for repair of skin defects in the philtrum

Crescentic subcutaneous pedicle flaps prepared on the area lateral to the alar base were designed to cover the skin defects in and around the philtrum. In 1 patient a combination of the lateral lip advancement flap and the crescentic subcutaneous pedicle flap was applied to the skin defect on the lateral lip and philtrum. In another patient, a combination of two crescentic subcutaneous pedicle flaps was applied to the skin defect within the philtrum. Both methods have been successful.     

New Technique for Correction of the Microform Cleft Lip Using Trans/Intraoral Approach

The traditional method of treating microform cleft lip with nose deformity uses upper lip external incision, finally leading to a small scar on the upper lip. Hereafter, we present a new method for the correction of microform cleft lip using trans/intraoral approach. The new surgical technique is characterized as (1) using trans/intraoral approach and no incisions on the skin of the upper lip, (2) reconstruction of the “cross” muscular structure using the abnormal muscular insertions at the base of nasal columella and the nasal alar to restore nose deformity, and (3) repair of the lip deformity using two small Z-plasties to get the aesthetic and functional outcome. Thirty patients with microform cleft lip were repaired with our technique, and good functional and aesthetic results of repaired noses and upper lips were obtained in most cases.     

单侧唇裂鼻与正常鼻鼻翼软骨连接组织的解剖组织学比较

探讨单侧唇裂鼻畸形鼻翼软骨周边连接组织的病理解剖变化。方法对４０例正常成人尸体鼻标本和３０例意单侧唇裂鼻畸形Ⅱ期手术患者进行了解剖，组织学及术中病理解剖，组织化学比较观察。结果 发现侧唇裂鼻和正常鼻在鼻翼软骨与临近皮肤，软骨，骨组织间，存在有６种鹅乐同的连接组织，两者间并无组织学质的区别和明显分差异，但唇裂鼻翼软骨各段扭曲与移位的程度与特点却不同，各段畸形特点与其周边连接组织的组织学特性有一定关系     

内窥镜鱼尾纹除皱术的颞额区应用解剖学

目的探讨单侧唇裂鼻畸形鼻翼软骨周边连接组织的病理解剖变化。方法对40例正常成人尸体鼻标本和30例(大于14岁)单侧唇裂鼻畸形Ⅱ期手术患者进行了解剖、组织学及术中病理解剖、组织学比较观察。结果发现单侧唇裂鼻和正常鼻在鼻翼软骨与临近皮肤、软骨、骨组织间,存在有6种特性不同的连接组织,两者间并无组织学质的区别和明显分布差异,但唇裂鼻翼软骨各段扭曲与移位的程度与特点却不同,各段畸形特点与其周边连接组织的组织学特性有一定关系。结论单侧唇裂形成时这些周边连接组织的组织学差异可能对鼻翼软骨各段扭曲与移位施加了不同的影响,是形成单侧唇裂鼻畸形特征性形态的内在病理解剖学基础。本研究结果对采用合理手段彻底矫正单侧唇裂鼻畸形有一定启示。     

单侧唇裂鼻与正常鼻鼻翼软骨连接组织的解剖组织学比较

目的探讨单侧唇裂鼻畸形鼻翼软骨周边连接组织的病理解剖变化。方法对４０例正常成人尸体鼻标本和３０例（大于１４岁）单侧唇裂鼻畸形Ⅱ期手术患者进行了解剖、组织学及术中病理解剖、组织学比较观察。结果发现单侧唇裂鼻和正常鼻在鼻翼软骨与临近皮肤、软骨、骨组织间，存在有６种特性不同的连接组织，两者间并无组织学质的区别和明显分布差异，但唇裂鼻翼软骨各段扭曲与移位的程度与特点却不同，各段畸形特点与其周边连接组织的组织学特性有一定关系。结论单侧唇裂形成时这些周边连接组织的组织学差异可能对鼻翼软骨各段扭曲与移位施加了不同的影响，是形成单侧唇裂鼻畸形特征性形态的内在病理解剖学基础。本研究结果对采用合理手段彻底矫正单侧唇裂鼻畸形有一定启示     

单侧唇裂继发鼻畸形修复新法

目的　矫正单侧唇裂继发鼻畸形。方法　基于对单侧唇裂鼻畸形的病理解剖学研究和对其畸形特征的认识,我们设计一种新的手术修复方法。手术经鼻端和患侧前庭联合切口,解剖、显露双侧鼻翼软骨,同时形成患侧前庭粘膜软骨瓣;在纠正鼻中隔软骨偏曲,松解患侧鼻肌复合体起点,使鼻翼脚无张力抬高后,再通过悬吊技术和粘膜软骨瓣的 Ｖ Ｙ 推进,将患侧鼻翼软骨进行整体旋转复位;最后,应用口轮匝肌上部纤维内收抬高鼻翼脚,用鼻肌复合体起点复位调整鼻孔形态,完成鼻畸形的矫正。结果　自１９９３ 年至今,经９２ 例实践,效果满意。结论　本手术方法具有切口暴露好、可直视操作、安全可靠等特点;患侧鼻翼软骨整体复位具有良好的临床效果。     

A combined therapy for the repair of alar defects that consists of a modified spiral flap and postoperative nasal stent

BackgroundThe repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.MethodsIn this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects.ResultsAll cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed.ConclusionOur preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.     

单侧唇裂继发鼻畸形修复新法

目的矫正单侧唇裂继发鼻畸形。方法基于对单侧唇裂鼻畸形的病理解剖学研究和对其畸形特征的认识,我们设计一种新的手术修复方法。手术经鼻端和患侧前庭联合切口,解剖、显露双侧鼻翼软骨,同时形成患侧前庭粘膜软骨瓣;在纠正鼻中隔软骨偏曲,松解患侧鼻肌复合体起点,使鼻翼脚无张力抬高后,再通过悬吊技术和粘膜软骨瓣的 V-Y 推进,将患侧鼻翼软骨进行整体旋转复位;最后,应用口轮匝肌上部纤维内收抬高鼻翼脚,用鼻肌复合体起点复位调整鼻孔形态,完成鼻畸形的矫正。结果自1993年至今,经92例实践,效果满意。结论本手术方法具有切口暴露好、可直视操作、安全可靠等特点;患侧鼻翼软骨整体复位具有良好的临床效果。     

单侧唇裂继发鼻畸形修复新法

OBJECTIVE: The aim of this work was to correct the secondary deformities of unilateral cleft lip nose. METHODS: On the basis of patho-anatomical study and the comprehension on the cleft lip nose, a new approach to correct the secondary deformities of unilateral cleft lip nose was designed and used. During operation, an intranasal and marginal combining incision was made to explore the alar cartilages and to from a mucosal-cartilage flap in the nasal vestibule. After the deformity of septal cartilage and the abnormalities of the alar base on the cleft side were repaired, the total alar cartilage was repositioned and rotated with suspension and V-Y advancement to correct the nasal deformities. RESULTS: Since 1993, a total of 92 cases were treated by the above procedure and satisfactory results were obtained. CONCLUSION: The clinical applications showed that there were several advantages for this method, and good results can be gained by repositioning the total alar cartilage on the cleft side.