A new modified forked flap and a reverse V shaped flap for secondary correction of bilateral cleft lip nasal deformities

Background The columella, nasal tip, lip relationship in the bilateral cleft lip nasal deformity remains a great challenge for plastic surgeon. An esthetically satisfying result is difficult to obtain. A subset of patients with bilateral cleft lip nasal deformity still require columellar lengthening and nasal correction and philtrial construction. This study aimed to provide a new method based on the forked flap to improve the final appearance of these patients. Methods A technique to correct this deformity is described. This consists of （1） a newly modified forked flap including the orbicularis oris muscle and nasalis muscle along the whole flap for columellar lengthening, （2） a reverse V shaped flap from the lower portion of the columella and the prolabium for normal size phitrum construction, （3） inserting the vermilion portion of the forked flap and advancing the nasal floor medially and anteriorly to lengthen and maintain the nasal septum side of the columella for proper tip positioning, （4） open rhinoplasty, allowing definitive repositioning of the lower lateral cartilages, （5） reconstruction of the orbicularis orismuscle as required, and （6） the flaring nostril floor advancing medially and constructing the sill. Results This technique was applied to 15 cases of secondary bilateral cleft lip nasal deformity. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the height of the prolabium was added with normal size philtrial dimensions. Conclusions This method makes maximum use of the tissue containing the scar in the lip and limits tissues in the lower portion of the columella and the prolabium for adequate columella elongation and reconstruction with normal size philtrial dimensions. It is a very reasonable and useful method in correction of secondary bilateral cleft lip nasal deformities.

A modified technique for the repair of secondary unilateral cleft nasal deformity

Objective To investigate the effect of a modified technique for reparing secondary unilateral cleft nasal deformity. Methods Nasal alar cartilage was explosed through dish - like incision,and base of naris was cut to loosening and replacing the orbicularis oris,releasing

Revision rhinoplasty for contracted nose:A systematic review and meta-analysis

Background:This study aimed to review treatments and evaluate the aesthetic outcomes,complications,and reoperation rates regarding surgical correction for a postoperative contracted nose.Methods:PubMed,MEDLINE,and Embase databases were searched for studies detailing aesthetic outcomes and complications of surgical correction of a contracted nose.Surgical procedures,adjuvant treatment,outcomes,and complications were synthesized and analyzed.Results:Nine articles encompassing 376 patients were included in the systematic review,and six articles(198 participants)were included in the meta-analysis.The most frequently used graft material was the autologous rib cartilage(61.1%).Surgical procedures were heterogeneous in these studies.The nasolabial angle reduced by 9.52°(95%confidence interval(CI):(-11.95,-7.09),P<0.0001),and the nasal length increased significantly(standardized mean difference(SMD)=2.25,95%CI:(1.26,2.23),P<0.00001).However,the evidence was insufficient to determine a significant change in the columellar-labial angle(SMD=-0.95,95%CI:(-2.19,0.29),P=0.13)and columellar-lobular angle(SMD=2.39,95%CI:(-1.20,5.97),P=0.19).Aesthetic dissatisfaction(12.5%)and infection(4.5%)were the most commonly reported complications.Reoperation was performed in 5.3%of patients.Conclusion:Surgical correction can increase the nasal length,reduce the nasolabial angle,and have a low reoperation rate.No significant improvement in the columellar-labial or columellar-lobular angle was observed.

Nasoalveolar molding:benefits and burdens

Nasoalveolar molding(NAM)has been glorified and maligned.Supporters argue that NAM improves cleft outcomes and reduces secondary procedures.Critics highlight the expense,labor intensity,and inconsistent or transient results.We offer NAM to our patients and have been doing so for over a decade;nevertheless,our benefits assessments are nuanced.In the following paper,we present our rationale,evolution,technique,and outcomes of NAM,augmented with an analysis of the literature.We offer another perspective in this ever-evolving area of evidence-based cleft palate care.