Cleft Lip Nose Correction Combining Open Rhinoplasty With the Dibbel Technique

Abstract

Cleft lip nose rhinoplasty is a challenging procedure because of the different presentation and severity of the deformity. Due to this presentation type, there is still no standard procedure correcting all the components of the deformity although a number of techniques have been published in literature. In this study, the effectiveness of the combination of open rhinoplasty and the Dibbel technique with nasal sill augmentation was evaluated. We hereby report our experience with 7 patients who had unilateral cleft lip nose deformity with slumped lower lateral cartilage and underprojected and deformed dome, operated on between September 2010 and April 2013 by 1 surgeon. The mean age of the patients at the time of surgery was 24.5 years (18-38 years) and the patients were followed up for an average of 18.5 months (6-31 months). All patients were operated on with open rhinoplasty and Dibbel technique combination with nasal sill augmentation. Frontal, lateral, oblique, and basilar photographs were obtained preoperatively and postoperatively for each patient. Nasal projection, columella height, nasolabial angle, nasal sill symmetry, and base width were measured on the photographs for comparison of preoperative and postoperative results. All patients' medial and lateral cantus distances were used for photographic standardization. The results demonstrated that there was a statistically significant increase in nasal projection (2.13 ± 0.28 mm preoperatively versus 2.31 ± 0.08 mm postoperatively; P = 0.018), columella height (1.07 ± 0.25 mm preoperatively versus 1.21 ± 0.18 mm postoperatively; P = 0.028), nostril apex height (1.11 ± 0.15 mm preoperatively versus 1.22 ± 0.11 mm postoperatively, P < 0.028), nasolabial angle (77.71 ± 8.74 mm preoperatively versus 91.33 ± 6.49 mm postoperatively; P < 0.05), and nasal sill symmetry (0.42 ± 0.15 mm preoperatively versus 0.27 ± 0.07 mm postoperatively; P < 0.05), and a significant decrease of alar width (2.35 ± 0.44 mm versus 2.16 ± 0.32 mm postoperatively; P = 0.018) on the affected side in response to surgery. The results of this study demonstrated that the Dibbel technique and open rhinoplasty combination with nasal sill augmentation is an effective and safe method for the correction of cleft lip nose deformity in respect to nasal symmetry.

The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty

“…Gundeslioglu et al describe using resected septal cartilage and/ or vomerine bone as a graft to be placed along the cleft-side piriform aperture in an en bloc fashion to elevate the nasal sill and nasal base. 8 This is performed in conjunction with an open rhinoplasty as an added maneuver to provide improved nasal symmetry, especially from the base view. Overall, the concept of grafting to the nasal base has been demonstrated to significantly improve the asymmetries of the cleft nose deformity.…”

Primary Nasal Correction in Unilateral Cleft Lip: An Ongoing Journey

“…Numerous authors have described a variety of primary nasal correction methods. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Where available the use of preoperative nasoalveolar molding (NAM) has revolutionized the management of cleft lip. [23][24][25][26][27][28] This not only helps to align the lip and alveolar segments but also helps to correct the nasal deformity.…”

“…Overall it is widely accepted that primary nasal surgery is beneficial and should be performed to give the children a better chance of being accepted as normal by peers. Numerous authors have described a variety of primary nasal correction methods 5–22 . Where available the use of preoperative nasoalveolar molding (NAM) has revolutionized the management of cleft lip 23–28 .…”