Craniomaxillofacial deformities/sleep disorders/cosmetic surgery
The Microsurgical Approach in Primary Cleft Rhinoplasty—An Anthropometric Analysis

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Purpose

Oral and maxillofacial surgeons use different approaches to repair the nasal deformity of patients with a cleft lip deformity, differing in technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the cleft nasal deformity at 4 to 6 weeks of life using a microscope.

Materials and Methods

Twenty-seven newborn patients with a cleft lip deformity were treated by primary repair of the nasal deformity using a microscope at 4 to 6 weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel (Plast Reconstr Surg 103:1491, 1999), and trans-columellar sutures. All patients were photographed at specific time points up to 1 year after surgery. Established angles and distances were analyzed and compared with normal values of age-matched children by Farkas (Anthropometry of the Head and Face [ed 2]. New York: Lippincott Williams and Wilkins, 1994).

Results

All parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values.

Conclusion

The authors recommend the early treatment of cleft nasal deformity using microscopic surgery because it shows stable and symmetrical results at least up to 1 year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.

Section snippets

Study Design

Fifty-nine patients with a unilateral cleft were treated with early microsurgical primary rhinoplasty from 2007 through 2015 at the Helios Kliniken Schwerin (Schwerin, Germany). Measurements at each time point were obtained for 27 of them, and they were included in this study. All newborns were Northern European Caucasians. Twelve were born with a unilateral cleft lip (UCL) and 15 were born with a UCL and palate (UCLP). At specific time points, indirect anthropometric measurements were obtained

Results

To assess the esthetic outcome of the treatment, the children's faces were examined for symmetry and normal nasal morphology. Symmetry was evaluated in 2 ways: by columellar deviation and by comparison of the nostrils. The mean preoperative columellar deviation was 48.5° for female patients and 32.8° for male patients with large standard deviations (Fig 5). As a marker for cleft severity, a large preoperative standard deviation indicates that the study sample contained a large variation in

Discussion

The authors present a primary microsurgical cleft lip and nose repair within the first weeks of life. This procedure allows the patient to grow up without the “cleft nose deformity.” Modern rhinoplasty techniques claim that growth is not disturbed through early correction of the deformity.4, 5, 30, 31 Kim et al6 argued that an early nose repair is less difficult and more successful than a later repair. Nonetheless, results of a survey in the United States indicated that only approximately half

References (35)

  • K. Salyer

    Unilateral cleft lip-nose repair: A 33-year experience

    J Craniofac Surg

    (2003)
  • H. McComb

    Primary correction of unilateral cleft lip nasal deformity: A 10-year review

    Plast Reconstr Surg

    (1985)
  • S.-K. Kim et al.

    Primary correction of unilateral cleft lip nasal deformity in Asian patients: Anthropometric evaluation

    Plast Reconstr Surg

    (2004)
  • H.K. McComb et al.

    Primary repair of the unilateral cleft lip nose: Completion of a longitudinal study

    Cleft Palate Craniofacial J

    (1996)
  • S. Tajima

    Follow-up results of the unilateral primary cleft lip operation with special reference to primary nasal correction by the author’s method

    Facial Plast Surg

    (1990)
  • C. Thomas

    Primary rhinoplasty by open approach with repair of unilateral complete cleft lip

    J Craniofac Surg

    (2009)
  • D. Dibbell

    Cleft lip nasal reconstruction: Correcting the classic unilateral defect

    Plast Reconstr Surg

    (1982)
  • Cited by (0)

    Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

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