CLINICAL QUESTION
Following primary surgery for unilateral cleft lip palate (UCLP), how effective is a secondary rhinoplasty technique using a nasolabial flap (NLF) combined with costal cartilage grafts for patients with unilateral cleft lip nasal deformities (CLNDs) and alar tissue deficiency?
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April 2024BOTTOM LINE
The NLF achieved satisfactory results in secondary rhinoplasty of unilateral CLND for patients with nasal tissue deficiencies in whom the surgeon weighed the potential benefits over postoperative scarring.
BACKGROUND: Unilateral cleft lip palate is a common congenital deformity requiring long-term, multistage, comprehensive treatment, and the need for secondary repair following primary surgery is common. Because secondary repair for nasal deformities requires reshaping and repositioning the patient’s ala, a deficiency of alar tissue poses a challenge for rhinoplasty surgeons.
STUDY DESIGN: Prospective study.
SETTING: Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China.
SYNOPSIS: Twelve patients with unilateral CLNDs who had undergone primary repair of UCLP and had a partial deficiency of alar tissue underwent surgery between 2020 and 2021. Researchers used a surgical technique that involved NLF with use of costal cartilage grafts to create a supporting cartilage framework and prevent collapse and malformation. Photogrammetric measurements were performed preoperatively and postoperatively. Twelve flaps were successfully transferred, and 10 patients were followed up on for at least a year. All flaps presented satisfactory outcomes with good blood supply. No implanted cartilage grafts exhibited structural collapse or deformation. The surgeries significantly narrowed the widths of the nasal alar base and cleft nostrils and increased the height of the cleft nostrils. No significant postoperative decrease was observed in the single-sided alar width of the cleft half of the nose, possibly due to a postoperative change in tension. None of the patients reported postoperative discomfort in the surgical area and, despite the additional facial scars that occurred in some cases, all were satisfied with the aesthetic effects. Study limitations included potential inaccuracies in the measurement process.
CITATION: Chen Y, Wang X, Wu J, et al. A new algorithm for secondary repair of unilateral cleft lip nasal deformity. Laryngoscope. 2024;134:1648–1655.