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Unilateral Cleft Lip Nasal Deformity: Foundation-Based Approach to Primary Rhinoplasty.

Authors
  • Tse, Raymond W1
  • Mercan, Ezgi
  • Fisher, David M
  • Hopper, Richard A
  • Birgfeld, Craig B
  • Gruss, Joseph S
  • 1 Seattle, Wash.; and Toronto, Ontario, Canada From the Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital; and the Division of Plastic Surgery, Hospital for Sick Children. , (Canada)
Type
Published Article
Journal
Plastic and reconstructive surgery
Publication Date
Nov 01, 2019
Volume
144
Issue
5
Pages
1138–1149
Identifiers
DOI: 10.1097/PRS.0000000000006182
PMID: 31688761
Source
Medline
Language
English
License
Unknown

Abstract

Cleft lip results in disruption of the nasal foundation and collapse of tip structures. Most approaches to primary rhinoplasty focus on correction of lower lateral cartilages; however, recurrent deformity is common, and secondary revision is frequently required. The authors describe an alternate approach that focuses on the foundation to "upright the nose," without any nasal tip dissection. This study assessed changes with surgery and with growth. Secondary goals were to compare methods of sidewall reconstruction and septoplasty and to identify predictors of relapse. Consecutive patients undergoing repair (n = 102) were assessed. Images were captured preoperatively, postoperatively, and at 5 years of age (when available) using three-dimensional stereophotogrammetry. Standard anthropometric and contemporary shape-based analysis (volume ratio, dorsal deviation, and alar-cheek definition) was performed to assess longitudinal changes. Images of age-matched normal control subjects were used for comparison. Significant changes in anthropometric and morphometric measurements occurred following surgery. Postoperative form was similar to controls immediately after surgery and at 5 years. Nasal corrections were satisfactory, and only two patients have elected to undergo revision. When subjects were grouped according to cleft type, we found the same trends. When comparing different methods of nasal sidewall reconstruction or septoplasty, we found no differences. Alveolar cleft width was a significant predictor of worse preoperative and postoperative form. Significant nasal correction can be achieved by means of reconstruction of nasal foundation, without nasal tip dissection. Preservation of tissue planes may allow for easier secondary revision, if necessary. Therapeutic, IV.

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