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Facial Plast Surg 2002; 18(3): 165-178
DOI: 10.1055/s-2002-33063
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Nasal Base in Cleft Lip Rhinoplasty

Gerhard Rettinger1 , Michael O'Connell2
  • 1University Clinic for Otorhinolaryngology, Ulm, Germany
  • 2Department of Otorhinolaryngology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Publication History

Publication Date:
30 July 2002 (online)

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ABSTRACT

The discussion on how to correct the nasal base in cleft lip (CL) rhinoplasty focuses on timing of the surgery, the type of approach, and the technique of repositioning the ala. Little attention is paid to the nasal vestibule. We compared the results of two different techniques. Forty-two patients were operated on via an endonasal approach with total mobilization of the lateral crus and fixation after repositioning. An external approach was used in 12 patients and the lateral crus freed as a medially based chondrocutaneous flap. The defect in the lateral vestibule wall was covered with an ear composite graft. The latter group showed more stable results concerning symmetry and breathing. We conclude that in most cases of unilateral CL noses there is not only a malposition and deformity of soft tissues and skin of the ala, but also a deficiency in the surface of inner lining of the nasal vestibule that needs appropriate repair. In general, the numerous procedures for repair of the nasal base in unilateral CL patients can be attributed to three principles based on different philosophies concerning the underlying pathology.

KEYWORDS

Unilateral cleft lip nose - secondary repair - surgical anatomy - surgical principles

REFERENCES

  • 1 Broadbent T R, Woolf R M. Cleft lip nasal deformity.  Ann Plast Surg . 1984;  12 216-234
    CrossrefPubMedSearch in Google Scholar
  • 2 McComb H K, Coghlan B A. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study.  Cleft Palate Craniofac J Hamilton (Ont) . 1996;  33 23-30
    CrossrefPubMedSearch in Google Scholar
  • 3 Cook T A, Davis R E, Israel J M. The extended Skoog technique for repair of the unilateral cleft lip and nose deformity.  Fac Plast Surg . 1993;  9 195-205
    PubMedSearch in Google Scholar
  • 4 Nakajima T, Yoshimura Y. Early repair of unilateral cleft lip employing a small triangular flap method and primary nasal correction.  Br J Plast Surg . 1993;  46 616-618
    PubMedSearch in Google Scholar
  • 5 Sugihara T, Yoshida T, Igawa H H, Homma K. Primary correction of the unilateral cleft lip nose.  Cleft Palate Craniofac J Hamilton (Ont) . 1993;  30 231-236
    PubMedSearch in Google Scholar
  • 6 Takato T, Yonehara Y, Susami T. Early correction of the nose in unilateral cleft lip patients using an open method: a 10-year review.  J Oral Maxillofac Surg . 1995;  53 28-33
    CrossrefPubMedSearch in Google Scholar
  • 7 Matthews D. The nose tip.  Br J Plast Surg . 1968;  21 153-167
    PubMedSearch in Google Scholar
  • 8 Rees T D, Guy C L, Converse J M. Repair of the cleft lip nose: addendum to the synchronous technique with full thickness skin grafting of the nasal vestibule.  Plast Reconstr Surg . 1966;  37 47-50
    PubMedSearch in Google Scholar
  • 9 Dibbell D G. Cleft lip nasal reconstruction: correcting the classic unilateral defect.  Plast Reconstr Surg . 1982;  2 264-270
    PubMedSearch in Google Scholar
  • 10 Gubisch W. How to obtain symmetry in a unilaterally cleft nose.  Eur J Plast Surg . 1990;  13 241-246
    CrossrefPubMedSearch in Google Scholar
  • 11 Jonsson C E. Secondary correction of the unilateral cleft nose deformity with an endonasal technique.  Eur J Plast Surg . 1993;  16 143-148
    PubMedSearch in Google Scholar
  • 12 Tajima S, Maruyama M. Reverse-U incision for secondary repair of cleft lip nose.  Plast Reconstr Surg . 1977;  8 256-261
    PubMedSearch in Google Scholar
  • 13 Kirschbaum J D, Kirschbaum C A. The chondromucosal sleeve for the secondary correction of the unilateral cleft lip nasal deformity.  Ann Plast Surg . 1992;  29 402-407
    PubMedSearch in Google Scholar
  • 14 Merville M L. L'asymétrie narinaire du bec-de-lièvre unilatéral correction chirurgicale secondaire.  Rev Stomatol Chir . 1962;  63 392-398
    PubMedSearch in Google Scholar
  • 15 Potter J. Some nasal tip deformities due to alar cartilage abnormalities.  Plast Reconstr Surg . 1954;  13 358-366
    CrossrefPubMedSearch in Google Scholar
  • 16 Goodman W S, Zorn M LT. The unilateral cleft lip nose.  J Otolaryngol Toronto . 1982;  11 198-203
    PubMedSearch in Google Scholar
  • 17 Nishimura Y, Kumoi T. External septorhinoplasty in the cleft lip nose.  Ann Plast Surg . 1991;  26 526-540
    PubMedSearch in Google Scholar
  • 18 Farrior R T. The cleft lip nose: an update.  Fac Plast Surg . 1993;  9 241-268
    PubMedSearch in Google Scholar
  • 19 Harashina T. Open reverse-U incision technique for secondary correction of unilateral cleft lip nose deformity.  Br J Plast Surg . 1990;  43 557-564
    CrossrefPubMedSearch in Google Scholar
  • 20 Koopmann C F, Krause C J. Secondary cleft lip rhinoplasty: an external approach.  Fac Plast Surg . 1988;  5 167-177
    PubMedSearch in Google Scholar
  • 21 Uchida J I. A new approach to the correction of cleft lip nasal deformities.  Plast Reconstr Surg . 1971;  5 454-458
    PubMedSearch in Google Scholar
  • 22 Huffman W C, Lierle D M. Studies on the pathologic anatomy of the unilateral hare-lip nose.  Plast Reconstr Surg . 1949;  4 225-234
    PubMedSearch in Google Scholar
  • 23 Millard Jr D R. Earlier correction of the unilateral cleft lip nose.  Plast Reconstr Surg . 1982;  1 64-73
    PubMedSearch in Google Scholar
  • 24 Hata Y. The vestibular fold [letter].  Br J Plast Surg . 1993;  46 345
    PubMedSearch in Google Scholar
  • 25 Fisher D M, Mann R J.. A model for the cleft lip nasal deformity.  Plast Reconstr Surg . 1998;  5 1448-1456
    PubMedSearch in Google Scholar
  • 26 Bumsted R M. Cleft lip and palate.  In: Papel JD, Nachlas NE, eds. Facial Plastic and Reconstructive Surgery. St. Louis: Mosby-Year Book Inc 1992: 546-556
    Search in Google Scholar
  • 27 Cutting C B, Bardach J, Pang R. A comparative study of the skin envelope of the unilateral cleft lip nose subsequent to rotation-advancement and triangular flap lip repairs.  Plast Reconstr Surg . 1989;  84 409-417
    CrossrefPubMedSearch in Google Scholar
  • 28 Sadove R, Ladaga L, Magee W P. Cartilaginous histology of the cleft lip nose: proving the extrinsic etiology.  Plast Reconstr Surg . 1988;  81 655-661
    PubMedSearch in Google Scholar
  • 29 Koh K S. Asymmetric incision for open rhinoplasty in cleft lip nasal deformity.   Plast Reconstr Surg . 1999;  6 1835-1838
    PubMedSearch in Google Scholar
  • 30 Tolhurst D E. Secondary correction of the unilateral cleft lip nose deformity.   Brit J Plast Surg . 1983;  36 449-454
    PubMedSearch in Google Scholar
  • 31 Cronin T D, Denkler K A. Correction of the unilateral cleft lip nose.   Plast Reconstr Surg . 1988;  3 419-432
    PubMedSearch in Google Scholar
  • 32 Rethi A. Über die korrektiven Operationen der Nasendeformitäten. <~>I. <~>Die Höckerabtragung.  Der Chirurg . 1929;  1 1103-1113
    PubMedSearch in Google Scholar
  • 33 Potter J. Secondary repair of flattened alae in the cleft lip deformity.   Chir Plast . 1984;  7 273-279
    PubMedSearch in Google Scholar
  • 34 Matsuo K, Hirose T. Secondary correction of the unilateral cleft lip nose using a conchal composite graft.  Plast Reconstr Surg . 1990;  86 991-995
    PubMedSearch in Google Scholar
  • 35 Kernahan D A, Bauer B S, Harris G D. Experience with the Tajima procedure in primary and secondary repair in unilateral cleft lip nasal deformity.  Plast Reconstr Surg . 1980;  1 46-53
    PubMedSearch in Google Scholar
  • 36 Kane A A, Pilgram T K, Moshiri M, Marsh J L. Long-term outcome of cleft lip nasal reconstruction in childhood.  Plast Reconstr Surg . 2000;  4 1600-1608
    PubMedSearch in Google Scholar

1 *The terminology of the nasal cartilages is somewhat different from the standard terms ``lower and upper lateral cartilages'' as we feel that these are not anatomically correct.