Unser Konzept der Rhinoplastik bei Patienten mit Lippen-Kiefer-Gaumenspalten*

Zusammenfassung

Die Korrektur der spaltbedingten Nasendeformität stellt eine besondere Herausforderung in der Therapie von Patienten mit Lippen-Kiefer-Gaumenspalten dar. Bei einseitigen Spalten findet sich fast immer eine ausgeprägte Septumdeformität mit resultierender Schiefhase. Da derart schwere Septumdeformitäten meist nicht in loco zu korrigieren sind, der Septumkorrektur jedoch eine zentrale Bedeutung für die Funktion der Nase zukommt, haben wir von Januar 1980 bis Mai 1993 bei 191 Spaltpatienten eine extrakorporale Septumkorrektur durchgeführt. Eine weitere Schwierigkeit stellt die Korrektur der asymmetrischen Nasenspitze und des deformierten spaltseitigen Naseneinganges dar. Hier hat sich uns eine dreifache Schwenklappentechnik im Bereich von Columella, Nasenflügel und Vestibulumhaut bewährt. Diese Technik haben wir bisher an 174 Patienten mit günstigen Ergebnissen angewandt.

Summary

In the treatment of patients with cheilognathouranoschisis, rhinoplasty is a great challenge, since the cleft lip and palate will also produce nasal deformation requiring surgical correction. Unilateral cleft lip and palate is usually associated with a pronounced septal deformity resulting in “crooked nose” as well as typical asymmetry of the apex of the nose and of the nasal vestibule. The anterior part of the septum is dislocated in the direction of the unaffected side and the lower border of the septum is at the same time subluxated to the opposite side. The dorsal part of the septum presents with a convex deformity towards the cleft side extending in horizontal and vertical direction. Severe septal deformities cannot usually be adequately corrected on the spot, i.e. loco, but since septal correction is of paramount importance for the appearance and functioning of the nose we performed an extracorporeal correction of the septum in 191 cleft patients during the period from January 1980 through May 1993. Another characteristic feature of the cleft nose is the oblique modiolus, or columella Cochleae, which is shortened on the cleft side, and the S-shaped deformity of the lateral alar cartilage, which presents with a cranial dislocation in the dorne, caudal deviation in the lateral part, and an overhanging ala. After correction of the entire cartilaginous nasal framework the surgeon is usually confronted with asymmetry of the soft tissue. Satisfactory correction can be achieved by means of a three-flap technique in the region of the modiolus, nasal ala and vestibular skin: A modiolus-based transpositional flap results in a symmetrical height of the modiolus. By means of a second transpositional flap which is based at the rim of the ala and turned into the nasal vestibule, the nasal ala can be elevated to a level that is symmetrical to the unaffected side. Elevation of these two flaps usually results in a minor defect in the dorne, which is corrected using a third flap from surplus of vestibular skin. We have so far successfully used this technique in 174 patients.

Schlüsselwörter

Spaltnase - Extrakorporale Septumkorrektur - Nasenspitzenkorrektur - Naseneingang - Weichteilasymmetrie - Dreifache Schwenklappenplastik

Key words

Cleft nose deformity - Extracorporeal septum correction - Nasal vestibule - Asymmetry of soft tissue - Three-flap technique