The Performance of Secondary Nasal Alar Base Revision for Unilateral Cleft Lip by Single YV-Plasty (the Importance of Overcorrection During Surgery)

Abstract

Although primary surgery for cleft lip has improved over time, the degree of secondary cleft or nasal deformity reportedly varies from a minimum degree to a remarkable degree. Patients with cleft often worry about residual nose deformity, such as a displaced columella, a broad nasal floor, and a deviation of the alar base on the cleft side. Some of the factors that occur in association with secondary cleft or nasal deformity include a deviation of the anterior nasal spine, a deflected septum, a deficiency of the orbicularis muscle, and a lack of bone underlying the nose. Secondary cleft and nasal deformity can result from incomplete muscle repair at the primary cleft operation. Therefore, surgeons should manage patients individually and deal with various deformities by performing appropriate surgery on a case-by-case basis. In this report, we applied the simple method of single VY-plasty on the nasal floor to a patient with unilateral cleft to revise the alar base on the cleft side. We adopted this approach to achieve overcorrection on the cleft side during surgery, which helped maintain the appropriate position of the alar base and ultimately balanced the nose foramen at 13 months after the operation. It was also possible to complement the height of the nasal floor without a bone graft. We believe that this approach will prove useful for managing cases with a broad and low nasal floor, thereby enabling the reconstruction of a well-balanced nose.

Rhinoplasty in Patients with Cleft Lip Nasal Deformity: Correcting the Alar Base

“…to address minor alar base asymmetries at the time of rhinoplasty or scar revision of the lip. 17 We have used similar techniques in the past to narrow the alar base (Figure 3). Other studies using 3D imaging looking at overall changes to multiple aspects of rhinoplasty, not just the alar base, and found improvement with alar positioning with suture techniques and conchal cartilage onlay grafts though with less significant, long-term changes.…”

“…16 Using photographic software for analysis, one group used a vomer bone graft secured with a lag screw and found a significant improvement in not only alar base and nostril positioning but also increasing the volume of the lip and improved nasal tip measurements. 17 Other cleft surgeons have attempted to address the alar deficiency with soft tissue techniques with varying degrees of success. One group used scar revision and V-Y type revisions to address minor alar base asymmetries at the time of rhinoplasty or scar revision of the lip.…”

“…One group used scar revision and V-Y type revisions to address minor alar base asymmetries at the time of rhinoplasty or scar revision of the lip. 17 We have used similar techniques in the past to narrow the alar base (►Fig. 3).…”