Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(S 01): S71-S78
DOI: 10.1055/s-0039-1699379
Review Article
Association of Plastic Surgeons of India

Composite correction of a unilateral cleft lip nose deformity and alveolar bone grafting

Nitin J. Mokal
Department of Plastic and Reconstructive Surgery, Grant Medical College and G. T. Hospital, Mumbai, India
,
Prabhash,
Chintamani Kale
Department of Plastic and Reconstructive Surgery, Grant Medical College and G. T. Hospital, Mumbai, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)

Also available at
  PDF Download Permissions and Reprints

ABSTRACT

Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there is no single established universally accepted method of correction. The open alveolar gap and the ipsilateral hypoplastic maxilla are two major problems in achieving consistently good results in a cleft lip nasal deformity. In our study, after first assuring the orthodontic realignment of maxillary arches, we combined bone grafting in the alveolar gap and along the pyriform margin, with a formal open rhinoplasty approach. Methods: All the patients underwent orthodontic treatment for preparation of the alveolar bone grafting. During the process of alveolar bone graft, a strip of septal cartilage graft was harvested from the lower border of the septum which also helps to correct the septal deviation. The cancellous bone graft harvested from the iliac crest was used to fill the alveolar gap and placed along the pyriform margin to gain symmetry. Through open rhinoplasty along the alar rim and additionally using Potter's incision extending to the lateral vestibule, the lateral crura of the alar cartilage on the cleft side was released from its lateral attachment and advanced medially as a chondromucosal flap in a V–Y fashion, in order to bring the cleft-side alar cartilage into a normal symmetric position. The harvested septal cartilage graft was used as a columellar strut. The cleft nostril sill was narrowed by a Y–V advancement at the alar base and any overhanging alar rim skin was carefully excised to achieve symmetry. Results: The results of this composite approach were encouraging in our series of 15 patients with no additional morbidity and a better symmetry of the nose and airway especially in the adolescent age group. Conclusion: This concept of simultaneous approach when appropriate for nasal correction at the time of alveolar bone grafting showed an encouraging aesthetic and functional outcome.

KEY WORDS

Alveolar bone graft - Columellar strut - V–Y advancement
 

  • REFERENCES

  • 1 Kernahan D. Ten year review of the Tajima technique. Plast Reconstr Surg 1984;49:178.
  • 2 Millard DR Jr. Unilateral cleft lip nose. Plast Reconstr Surg 1964;34:169.
  • 3 Millard DR Jr. Earlier correction of cleft lip nose. Plast Reconstr Surg 1982;70:64.
  • 4 Stenstrom SJ. The alar cartilage and the nasal deformity in unilateral cleft lip. Plast Reconstr Surg 1966;38:223.
  • 5 Stenstorm SJ. Correction of cleft lip nose deformity: A refinement of an older method. Plast Reconstr Surg 1977;59:675.
  • 6 Tajima, S., Maruyama, M. Reverse U- incision for secondary repair of cleft lip nose. Plast. Reconstr. Surg. 60:156, 1977.
  • 7 Ahuja RB. Primary rhinoplasty in unilateral cleft patients the ‘limited open’ approach and other technical considerations. Cleft Palate Craniofac J 2006;43:492.
  • 8 Cutting CB. Secondary cleft lip nasal reconstruction: State of the art. Cleft Palat Craniofac J 2000;37:538.
  • 9 Ortiz-Monasterio F, Olmedo A. A corrective rhinoplasty before puberty: A long term follow-up. Plast Reconstr Surg 1981;68:381.
  • 10 Sayler KE, Genecov ER, Genecov DG. Unilateral cleft lip nose repair: A 33 years experience. J Craniofac Surg 2003;14:549.
  • 11 Bergland O, Semb G, Abyholm F. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J 1986;23:175.
  • 12 Brauer R, Cronin T, Reaves E. Maxillary orthopedics, orthodontia and alveolar bone grafting in complete cleft of the palate. Plast Reconstr Surg 1962;29:625.
  • 13 Potter J. Some nasal deformities due to cartilage abnormalities. Plast Reconstr Surg 1954;13:358.
  • 14 Rees TD. Repair of the cleft lip nose. Plast Reconstr Surg 1966;37:47.
  • 15 Broadbent TR, Wolf RM. Cleft lip nose deformity. Ann Plast Surg 1984;12:216.
  • 16 Nishimura Y, Kumoi T. External septorhinoplasty in the cleft lip nose. Ann Plast Surg 1991;26:526.
  • 17 Bardach J, Salyer K. Surgical techniques in cleft lip and palate. Chicago Year Book Medical Publishers; 1987.
  • 18 Omberdanne L. Reconstruction of nostril in simple harelip. Presse Med 1921;29:703.
  • 19 Saxby PJ, Palmer JH. The use of an independent panel to assess result of cleft lip repair. Br J Plast Surg 1986;39:373.
  • 20 Bearn DR, Sandy JR, Shaw WC. Photogrammetric assessment of the soft tissue profile in unilateral cleft lip and palate. Cleft Palate Craniofac J 2001;39:597.