Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft

Han, Jihyeon; Baek, Rong Min; Kim, Baek Kyu

doi:10.1097/sap.0000000000000934

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…35 The surgical indications and options for correction or prevention of alar rim deformities in rhinoplasty include a variety of graft techniques such as the alar contour, alar spreader, lateral crural strut, and lateral crural spanning. [26][27][28][29][30][31][32][33][34][35][36][37][38] The lateral crural strut graft uses an autogenous cartilage graft sutured to the deep surface of the lateral crus just anterior to the vestibular skin. 28 The lateral end of the strut extends to the pyriform rim and is positioned caudal to the alar groove and the accessory cartilages.…”

Section: Discussionmentioning

confidence: 99%

“…However, the strength and anatomic positioning of the lateral crus are paramount to the location, contour, and stability of the alar. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Repositioning of both LLCs can effectively correct a laterally spreading dome and drooping nasal tip. [21][22][23][24][25] Several studies have described valuable procedures that address the challenges of hypoplastic cleft LLC and alar rim deformity in secondary CLND.…”

mentioning

confidence: 99%

“…[23][24][25] The alar contour graft, or alar spreader graft, is essential to correct the concave, collapsed, or retracted alar. [26][27][28][29][30][31][32][33][34][35][36][37][38] In addition, the columella strut affords enhanced structural integrity to the lower third of the nose, particularly the lower crura. [39][40][41][42][43][44] We have operated on adult patients with secondary CLND for 15 years by repositioning both LLCs, the columella strut, and the nasal tip plasty through the open reverse-U incision.…”

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confidence: 99%

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Correction of Severe Secondary Cleft Lip Nasal Deformity

Cho

Park

Ryu

et al. 2021

Journal of Craniofacial Surgery

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Background: The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. Methods: Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. Results: The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. Conclusions: The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Correction of Severe Secondary Cleft Lip Nasal Deformity

Cho

Park

Ryu

et al. 2021

Journal of Craniofacial Surgery

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“…By reapproximating the muscle sling at the alar base, total lip takedown with anatomic orbicularis oris reapproximation was associated with increased symmetry at the alar base and vertical lip height. Han et al (2017) claimed that the lateral crural turnover flap with sandwiched strut graft is a useful technique for reinforcing, repositioning, and reshaping the lower lateral cartilage in cleft lip patients with hyperconcave lateral crus and hypoplastic pyriform margin. Combined with other techniques, the nostril is increased in height, decreased in width, and thus satisfactory symmetry is obtained.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography–Assisted Auricular Cartilage Graft for Depression of the Alar Base in Secondary Unilateral Cleft Lip Repair: A Preliminary Report

Chen

Fang

et al. 2018

The Cleft Palate-Craniofacial Journal

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“…They are referred to by multiple authors, as the "rule rather than exception". (Allori and Mulliken, 2017), (Han et al, 2017), (Tse et al, 2019) Secondary nasal deformity is both intrinsic to the anomaly and iatrogenic. Causes include lack of surgeon experience, deficiencies of tissue, individual scar formation, and the effects of facial growth, the last of which cannot be underestimated.…”

Section: Introductionmentioning

confidence: 99%

Labial-Nasal Evaluation for Nasal Floor Reconstruction With the New Triangular Flap in Unilateral Cleft Lip Repair

Liu

Yao

et al. 2021

The Cleft Palate Craniofacial Journal

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In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. ( P < .05). In addition, statistical significance was detected in the 1-year postoperative columellar angle, alar width ratio, nostril width ratio, nostril height ratio, and nostril shape (cleft) ( P < .05), showing more successful repair of the nose compared with the traditional repair. The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry.

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Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft

Cited by 10 publications

References 28 publications

Correction of Severe Secondary Cleft Lip Nasal Deformity

Correction of Severe Secondary Cleft Lip Nasal Deformity

Computed Tomography–Assisted Auricular Cartilage Graft for Depression of the Alar Base in Secondary Unilateral Cleft Lip Repair: A Preliminary Report

Labial-Nasal Evaluation for Nasal Floor Reconstruction With the New Triangular Flap in Unilateral Cleft Lip Repair

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