A Comparative Study of the Skin Envelope of the Unilateral Cleft Lip Nose Subsequent to Rotation-Advancement and Triangular Flap Lip Repairs

Clefts of the lip and palate are among the most common congenital malformations. A unilateral deformity is the most common type of cleft, but even within this subgroup there is a great deal of variety due to the accompanying severe distortion of the upper lip, cheek, nose, and maxilla. To repair such a variety of clefts with good aesthetic results, several general incisional approaches should be mastered along with a variety of subtle techniques that improve the end product. The most common repair utilized in America is the Millard rotation-advancement technique. This is partly due to the perceived superiority in results compared with other repairs and the ease with which this repair can be taught to residents. This repair places the scar along an artificial philtral column and is often quite sufficient in small clefts. Unfortunately, adoption of this “one size fits all” approach can limit the arsenal of the surgeon facing the vast array of differing cleft lip deformities. For example, the modified triangular flap, or Tennison-Randall repair, can be of value when presented with the wider unilateral cleft lip. In an effort to not only demonstrate that excellent results can be achieved when incisional patterns (Millard and Tennison) are used appropriately (small versus large clefts), we compared the results of two types of repairs, performed by a single surgeon over a period of 30 years. In addition, a variety of subtle techniques are reviewed to assist in obtaining excellent aesthetic results for any size repair.

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A comparison between Millard rotation advancement flap and Tennisonʼs triangular flap repair in follow-up of cleft lip patients

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199002000-00073 ◽

1990 ◽

Vol 85 (2) ◽

pp. 325 ◽

Cited By ~ 1

Author(s):

Jung Sung Gyun

Keyword(s):

Cleft Lip ◽

Advancement Flap ◽

Triangular Flap ◽

Flap Repair ◽

Rotation Advancement

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Three-dimensional facial morphology, following primary cleft lip repair using the triangular flap with or without rotation advancement

Journal of Cranio-Maxillofacial Surgery ◽

10.1054/jcms.2002.0320 ◽

2002 ◽

Vol 30 (6) ◽

pp. 337-342 ◽

Cited By ~ 16

Author(s):

Tomohiro Yamada ◽

Yoshihide Mori ◽

Katsuhiro Minami ◽

Katsuaki Mishima ◽

Toshio Sugahara

Keyword(s):

Cleft Lip ◽

Three Dimensional ◽

Facial Morphology ◽

Triangular Flap ◽

Cleft Lip Repair ◽

Rotation Advancement

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The Anchor of the Nasal Ala in Cleft Lip-Nose Patients: A Morphological Description and a New Surgical Approach

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2000_037_0130_taotna_2.3.co_2 ◽

2000 ◽

Vol 37 (2) ◽

pp. 130-136

Author(s):

Paolo G. Morselli

Keyword(s):

Surgical Technique ◽

Cleft Lip ◽

Normal Growth ◽

Alar Cartilage ◽

Morphological Description ◽

Triangular Flap ◽

Primary Rhinoplasty ◽

The Face ◽

Cleft Lip Nose ◽

New Surgical Technique

Objective The purpose of this article is to describe a morphological condition that is readily seen in both primary and secondary deformed noses of cleft patients and to present a new surgical technique to correct this specific deformity that afflicts the alar dome. This anomaly resembles a taut cord-like tissue that runs vertically from the pyriform aperture and is anchored onto the alar cartilage, thus impeding the cartilage's normal growth process. This new surgical technique releases the anchor and corrects the deformity of the nasal rim by using a triangular flap V-Y advancement technique. Results From 1994 to 1997, 88 cleft lip-nose cases were operated on by the author using the triangular flap V-Y advancement technique for releasing the anchor. Forty-two cases were primary repairs and 46 were secondary repairs. Conclusions By studying the normal and pathological anatomy of the nose and its proportions, the surgeon can obtain ideas for new surgical corrective techniques that can be used to restore anatomical balance and harmony between the nose and the face. Only in the last 15 to 20 years has the plastic surgeon begun to be interested in primary rhinoplasty in cleft lip-nose patients. Within this time, many different techniques have been proposed. All primary and secondary cases that have undergone this specific technique for release of the anchor have shown good results for restoring the height of the alar dome's affected side to that of the noninvolved side, thus establishing a more anatomically balanced nose.

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