Resorbable Internal Splint: An Adjunct to Primary Correction of Unilateral Cleft Lip-Nasal Deformity

Abstract

There is usually some relapse in position of the alar cartilage after primary repair of unilateral cleft lip. Therefore, preoperative or postoperative external splinting has been recommended to supplement either closed or open suspension of the alar cartilage. The authors present a method using a resorbable internal nostril splint to shield the positioned alar cartilage from deformational forces caused by scar, and thus avoiding the problems associated with external splinting. An internal nasal splint was placed in 15 infants during repair of unilateral complete cleft lip and nasal deformity. The nasal morphology was compared with that of 15 control patients who had the same nasolabial procedure without internal splinting. Average follow-up time was 20.4 months (range, 4 to 30 months). Photogrammetric analysis showed that asymmetry of the alar contours averaged 8.6 percent in the splinted patients, as compared with 23 percent for controls (p <0.01). Thus, alar asymmetry was decreased two-thirds in the splinted group. An internal resorbable nasal splint is an adjunct to open alar suspension in primary repair of the unilateral cleft lip nasal deformity. An internal nasal splint protects the corrected alar cartilage longer than an external splint and eliminates drawbacks, such as necrosis, cutaneous depression of the nostril sill, and patient noncompliance. This strategy of temporary internal support of healing cartilage has other applications.

Avaliação de parâmetros antropométricos nasais após queiloplastia primária pela técnica de Mohler

“…Minimal changes in the distance between the photograph and the patient may lead to changes in the final measurements calculated in each photo. Therefore, obtaining mathematical ratios, as described by Wong et al 11 , reduces the error that results from any change in the distance between photographer and patient. From the methods of quantifying results that have been suggested in the literature, quantification of measurements through 2-dimensional photography was chosen, because it is an objective, reliable, and reproducible method without the high financial costs of 3-dimensional photography.…”

“…Cutting 10 , Wong et al 11 , and Mulliken and Martínez-Pérez 12 proposed technical modifications of primary rhinoplasties that provided significant improvement in the nasal symmetry of cleft patients. Cutting 10 intensified the work on the nasal area, altered the traction sutures of McComb 9 , and transformed them into percutaneous sutures with the knot fixed in the internal region of the nose.…”

“…This maneuver avoids scarring on the child's skin and the sutures have the same effectiveness as traction sutures. Wong et al 11 completely loo sened the entire region of the alar cartilages, replaced it in a more appropriate anatomical region, and, afterward, included a resorbable internal splint in the nose that prevents relapse of the nasal deformity.…”

Primary Unilateral and Bilateral Cleft Lip and Nose in An Older Population

“…This required repositioning the alar cartilages to their anatomical position when adequate lip exposure had been achieved at the time of surgery. The alar cartilages were then supported by a suture technique that did not entail any intranasal incisions (2). Using the rotation advancement principle, sufficient lip length was achieved.…”

Initial Management of Total Nasal Septectomy Defects Using Resorbable Plating

“…37 Although resorbable plating has been demonstrated to be biocompatible when used for internal fixation of cartilage, 38 application of resorbable plating to nasal reconstruction has lagged behind other craniofacial applications. Wong et al 39 recently reported use of resorbable plating strips as temporary batten grafts for stenting the nostril during recovery after repair of unilateral cleft lip-nasal deformity. Boenisch and Mink 25 and Boenisch et al 40 reported some benefit with use of resorbable foil as a substrate to hold free autografts of quadrilateral cartilage in the midline during septoplasty.…”