Modified forked flap for controlling columella length in cleft lip open rhinoplasty

Carlino, F.

doi:10.1016/j.jcms.2008.01.001

Cited by 11 publications

(4 citation statements)

References 16 publications

(12 reference statements)

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“…This in itself will influence the short and longterm aesthetic (soft tissue and facial skeletal appearance) (Nagy and Mommaerts, 2007;Nollet et al, 2007) and functional (occlusal and speech) outcomes (Joos et al, 2006). In addition, the type of surgical repair and at what age it is performed also has a significant influence on the aesthetic (Carlino, 2008) and functional (Li et al, 2006) outcomes. The major challenge is not only understanding the genetics involved (Dostal et al, 2009), but also the design of the surgical procedure required in the uncommon types of clefts (Bütow, 2007).…”

Section: Introductionmentioning

confidence: 99%

A classification and construction of congenital lateral facial clefts

Bütow

Botha

2010

Journal of Cranio-Maxillofacial Surgery

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SUMMARY. Background: The repair of the lateral or transverse facial cleft is a surgical challenge on the account of the abnormal positioning and appearance of the cleft. Materials and methods: Over a twenty-seven year period, 22 lateral facial cleft cases were evaluated at a cleft lip (CL) and palate clinic and seven children underwent reconstruction of the lateral CL. Results: Twenty-two of 3187 (0.69%) cases presented with a lateral CL. Five of these 22 cases (23%) had a bilateral, eight (36%) had a right-sided and nine (41%) had a left-sided cleft. The evaluation of these cases resulted in a new classification (namely an extension of the Tessier 7 cleft) classification for the cutaneous and muscle involvement: a superior (T7.1), middle (T7.2), inferior (T7.3) and agenetic (T7.4) lateral CL. The altered surgical construction: an internal mucosal straight-line closure, a curved cutaneousemucosal red-lip/vermilion-lined flap for the lip commissure, muscle reconstruction at the modiolus and a positional cutaneous z-plasty for the rare lateral cutaneous cleft. Conclusion: The paper introduced a new classification for the lateral CL, as well as an altered surgical reconstructive technique for the most natural functioning of the lateral part of the face. Ó 2010 European Association for Cranio-Maxillo-Facial Surgery

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Section: Introductionmentioning

confidence: 99%

A classification and construction of congenital lateral facial clefts

Bütow

Botha

2010

Journal of Cranio-Maxillofacial Surgery

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“…A forked flap and its modified methods are still used in many institutions, because it enables reliable lengthening of the columella and the simultaneous revision of lip scars in the cases of a moderately short columella, although it might leave conspicuous scars around the columella base. 6,10–13,18 Our modified design seems to resemble the forked flap and reverse V-shaped flap reported by Yan et al 11 in the point that the tip of the V-shaped philtrum flap is extended across the columella base to the lower area of the columella. However, in our method, the V-shaped philtrum flap is not advanced backward as is the V-Y advancement flap except in cases of a severely short prolabium.…”

Section: Discussionmentioning

confidence: 81%

“…A short forked flap could also be applied. 10 Cheon and Park 17 reported elongation of the columella using a composite graft instead of a skin flap. They showed excellent results on elongation of the columella by composite grafts, but there remain difficulties regarding graft take, postoperative pigmentation, and color mismatch.…”

Section: Discussionmentioning

confidence: 99%

Conchal Cartilage Graft for Correction of Bilateral Cleft Lip Nasal Deformities during Childhood

Masuoka

Kawai

Morimoto

et al. 2014

Plastic and Reconstructive Surgery Global Open

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Background:Various methods for primary repair of bilateral cleft lip have been developed, but they often produce inadequate results, such as an upturned nose or a short columella. We perform primary lip repair with muscle reconstruction to correct depression of the nasal floor and inferoposterior displacement of the alar base. Then, open rhinoplasty to project the nasal tip is performed during childhood. This article describes the methods and results of open rhinoplasty for bilateral cleft lip patients.Methods:Open rhinoplasty with a modified forked flap is performed. The harvested conchal cartilage is grafted as a strut to strengthen and extend the septum. The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position. Before skin closure, the tips of the 2 V flaps of the forked flap and the reverse V-flap between the forked flap are trimmed. Three trapezoidal flaps are sutured to the base of the columella. Thirty patients with bilateral cleft lip nasal deformities have undergone surgery. The operative results of 15 of 30 patients were evaluated photogrammetrically.Results:The nose was refined and more projected. The nasolabial angle and the nasal tip projection were improved. The reformed configuration was well maintained for many years. Photogrammetric analysis demonstrated increases in both the nasal height-to-width ratio and the nostril height-to-width ratio and a decrease in the nasolabial angle.Conclusions:Open rhinoplasty during childhood using 3 trapezoidal flaps and conchal cartilage graft improves bilateral cleft lip nasal deformities effectively.

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“…Carlino, in 2008, described the use of a modified forked flap for controlling columella length in cleft rhinoplasty in a small number of patients. 11 Carlino used a modification of the classical forked flap for controlling the tension created by the columellar suture in effort to reduce the tip projection gained by the technique. Carlino described the columella incision followed the classic tepee shape, although the inverted V was extremely narrow and long, with its arms extending beyond Figure 2 (A to G) Pre-and postoperative views of a patient who is 2 years status post sliding flap cleft rhinoplasty with ear cartilage structural grafting and septoplasty.…”

Section: Other Techniques In Secondary Cleft Rhinoplastymentioning

confidence: 99%

Revision of the Cleft Lip Nose

Angelos

Wang²

2012

Facial plast Surg

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Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.

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Modified forked flap for controlling columella length in cleft lip open rhinoplasty

Cited by 11 publications

References 16 publications

A classification and construction of congenital lateral facial clefts

A classification and construction of congenital lateral facial clefts

Conchal Cartilage Graft for Correction of Bilateral Cleft Lip Nasal Deformities during Childhood

Revision of the Cleft Lip Nose

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