Nasal deformity after bilateral cleft lip repair

Primary nasal deformity is characterized by apparent prolabio-columellar skin shortness due to alar cartilage dislocation worsened by lack of muscular support. The secondary deformation retains part of the initial deformity, sometimes even worsened by the primary lip repair. Multiple surgical lengthening techniques were used in nasal defect correction, suggesting both technical complexity and unsatisfactory results. Indeed, columellar insufficiency has more to do with abnormal columello-apical skin distribution due to alar mispositioning than an effective lack of skin. Secondary correction by open rhinoplasty allowing careful cartilage reconstruction of the nose tip seems to be widely accepted. However, the nasal defect can be limited by performing a primary intervention focusing on two principles: columellar lengthening by early alar repositioning and simultaneous lip and nose repair.     

单侧唇裂修复术改善鼻部畸形

目的探讨单侧唇裂修复手术对鼻部畸形的治疗影响。方法我院2002年至2006年收治单侧唇裂186例,回顾分析其手术方式与鼻唇部修复情况。结果单侧唇裂修复术后,鼻畸形35例,其中Millard法修复术后鼻畸形12例（12/77,15.6%）;Tennison法修复16例（16/56,28.6%）,上旋转下三角瓣法修复7例（7/53,13.2%）。结论对于单侧唇裂,选择适宜的手术方式,可同期修复鼻部畸形,减少患者痛苦。     

Rhinoplasty in unilateral cleft lip nasal deformity

An operation is described for correction of unilateral cleft lip nasal deformity which has had considerable uniformity of success and is applicable to both mild and severe degrees of deformity. Our proposed repair technique is performed through an external rhinoplasty approach and depends on repositioning of the displaced and deformed cartilages together with the reinforcement of the structural support of the nose by using multiple cartilage grafts. This surgical technique was used in 18 consecutive adult patients with unilateral cleft lip nasal deformity and yielded consistently good long-term functional and cosmetic results.     

Lip adhesion in bilateral cleft lip

Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. This is particularly true with asymmetrical, incomplete-complete clefts; and with symmetrical, complete clefts with marked protrusion of the premaxilla. Although the lip adhesion procedure has been used with success in certain unilateral clefts, its possible role in the bilateral deformity is less well defined and accepted. The purpose of this report is to propose that lip adhesion has advantages in certain bilateral deformities and to describe a technique for one-stage bilateral adhesions.     

Labial sequels after uni- and bilateral cleft lip repair

Children born with labial-alveolar-velopalatine clefts must be managed by multidisciplinary teams in order to decrease the frequency and the importance of sequels, by implementing a true therapeutic strategy. It is indeed easier to avoid a secondary deformation than to correct it. Labial sequels are often associated to nasal sequels, and are managed in a single surgical intervention, with total revision of the cheilorhinoplasty. Some less important labial deformities can be corrected without total and simultaneous revision of the lip-nose complex. The goal of correction is functional and aesthetic, and the choice of the moment depends mainly on the psychological impact of the deformation for the child, and his motivation for reoperation.     

Effects of cleft lip and palate on the nasal airway in children

Clefts of the lip and palate often produce significant nasal deformities and reduced nasal airway size. The purpose of this study was to assess how type of cleft affects nasal cross-sectional area and mode of breathing. The pressure-flow technique was used to estimate nasal airway size and modified inductive plethysmography was used to determine percent of nasal breathing in 60 children with cleft lip and palate aged 6 to 15 years. Ninety-five normal children served as controls. The data demonstrate that nasal size decreased among cleft types as follows: children with bilateral cleft lip and palate had largest airway, followed by unilateral cleft lip, cleft of the hard and soft palate, cleft of the soft palate, and unilateral cleft lip and palate. The data also indicated that most subjects with cleft were mouth breathers. Results of otolaryngologic examinations suggest that septal deformities affecting nasal valve function are responsible for much of the impairment, especially in the group with unilateral cleft lip and palate. The differences among groups appear to relate to developmental differences associated with the original defect and the surgical procedures used in primary repair.     

Prolabial lengthening by Turkish tulip method in bilateral cleft lip repair

OBJECTIVE: In bilateral cleft lip, there is a characteristic deformity called cleft lip nose characterized by short columella and prolabium with a pressed nose. Although lots of surgical techniques were described for columella lengthening and correction of the nose deformity, no technical method was suggested for prolabium lengthening. STUDY DESIGN: In this paper we propose a simultaneous bilateral cleft lip repair and lengthening of the prolabium, and describe a new technique called "Turkish tulip" for this aim. PATIENTS AND METHOD: Eleven patients (6 males and 5 females) with bilateral cleft lip were treated using this method. Patients' ages ranged from 3 months to 17 years at the time of operation. Five patients had incomplete and six had complete bilateral cleft lips. The patients were evaluated in terms of functional and aesthetic results in postoperative period. RESULTS.: The average follow-up time was 8 months (ranged from 4 months to 15 months). There were no postoperative complications. The prolabium was lengthened adequately in all patients. No notch and whistle deformity was seen in our series. The patient or parent satisfaction was good or perfect in all cases. CONCLUSIONS: To avoid the disadvantage of the long time course required to correct the nose deformity and to lengthen the prolabium, we propose the "Turkish tulip" technique with the primary repair of bilateral cleft lips simultaneously. With this technique it is possible to lengthen the columello-prolabial complex with cleft lip repair in the same session without any intervention to any part of the nose including the columella. As a preliminary study, according to the early results, this new technique seems to have good cosmetic outcomes.     

Functional and aesthetic outcome of nasal surgery in cleft lip palate patients]

Between June 1996 and November 2000 60 patients suffering from severe nasal dysplasia due to cleft lip and palate (CLP) underwent corrective nasal surgery. Diagnoses included 37 cases of unilateral CLP and 23 cases of bilateral CLP. Age ranged from 7 to 50 years. To assess functional outcome three different methods were used pre- and postoperatively with and without nasal decongestion: active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry. For the measurement of esthetic changes frontal, lateral, and caudal photographs were analyzed. Compared to a non-cleft population esthetic and functional impairment was evident preoperatively. Postoperatively a statistically significant improvement in nasal projection and configuration was seen. Concerning nasal respiration an improvement in nasal flow and hydraulic diameter was noted in the unilateral CLP group only, whereas a statistically nonsignificant average deterioration was found in the bilateral CLP group. No correlation existed between external nasal form or the change in nasal appearance and nasal function. Whereas the esthetic outcome of nasal surgery is covered by way of photo-analysis in many centers, a distinct lack of measuring the effects on nasal function can be stated. Without using objective methods, however, no data for improving surgical procedures and for internal quality control are at hand.     

Management of severe bilateral nasal wall collapse

OBJECTIVE: The aim of this study was to examine and analyze the pathology contributing to severe bilateral nasal wall collapse seen in certain revision rhinoplasty patients and identify those surgical maneuvers in the previous nasal surgery, which may have contributed to this complication; suggest alternatives or modifying steps in nasal surgery to prevent lateral wall collapse; analyze consecutive revision rhinoplasties and identify those patients who have complete bilateral nasal collapse at the internal nasal valve; and analyze the results achieved after surgical reconstruction of complete bilateral nasal collapse. PATIENTS: We identified 49 patients, who presented from 1990 to 2000 for revision surgery, who had bilateral collapse of the upper lateral cartilage. All patients had at least one previous rhinoplasty and all but 14 patients had undergone two or more procedures. The patients were reconstructed with a conchal cartilage graft placed through an external rhinoplasty approach. RESULTS: All patients complained of nasal obstruction with forced nasal inspiration. The collapse was visualized on inspiration and when prevented with intranasal positioning of a bayonet, all patients experienced an immediate improvement in nasal breathing. Postoperatively, all patients experienced this same improvement in their nasal airway. Collapse was not identified in any of the patients after surgery. Two patients underwent revision because of cosmetic asymmetries. CONCLUSION: We strongly recommend a cartilage overlay to reconstitute the rigid midline continuity of the upper lateral cartilages. Unfortunately, with any significant hump removal, this structural interruption is, to varying degrees, inevitable in most rhinoplasty techniques. The upper lateral cartilages can be sutured to circumvent some of the inferior drift, but this will not reconstitute the rigid lateral cantilever effect of the intact cartilage.