Alar Base Augmentation Using Vomerine Bone Graft in Patients With Cleft Lip Nasal Deformity

2020 ◽  
Vol 85 (5) ◽  
pp. 511-515
Author(s):  
Bassem Elfeki ◽  
Amr Mohamed Elhussiny Khater ◽  
Ahmed Mohamed Bahaa El-Din ◽  
Omar Ossama Shouman ◽  
Rong-Min Baek ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Nasal Deformity ◽  
Alar Base

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

2021 ◽  
pp. 105566562110106
Author(s):  
Yoshitaka Matsuura ◽  
Hideaki Kishimoto
Keyword(s):  
Cleft Lip ◽  
Minimum Degree ◽  
Nasal Deformity ◽  
Simple Method ◽  
Primary Surgery ◽  
Base Revision ◽  
Alar Base ◽  
Anterior Nasal Spine ◽  
Nasal Floor ◽  
Case Basis

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.

The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts

2017 ◽  
Vol 54 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Stephanie M. Power ◽  
Damir B. Matic
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Nonparametric Tests ◽  
Single Stage ◽  
Base Position ◽  
Alar Base ◽  
Alveolar Bone Grafting ◽  
Tertiary Center ◽  
Long Term Follow Up

Objective To compare effects of secondary cleft procedures on alar base position and nostril morphology. Design Retrospective review. Setting Multidisciplinary cleft clinic at tertiary center. Patients, Participants Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Interventions Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Main Outcome Measures Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Results Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base ( P < .001), increased vertical lip dimension ( P < .001), and decreased nostril height ( P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support ( P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view ( P < .04). Conclusions Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

Facial Symmetry in Unilateral Cleft Lip and Palate following Alar Base Augmentation with Bone Graft: A Three-Dimensional Assessment

2007 ◽  
Vol 44 (4) ◽  
pp. 391-395 ◽  
Author(s):  
Mark F. Devlin ◽  
Arup Ray ◽  
Peter Raine ◽  
Adrian Bowman ◽  
Ashraf F. Ayoub
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Facial Symmetry ◽  
Alar Base ◽  
Student’S T ◽  
A Prospective Study ◽  
Dimensional Assessment

Objective: The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry. Design: This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry. Patients: This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented. Results: Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p = 0.005). Conclusions: 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

scholarly journals Problems In Cleft Lip Nose Patients Undergoing Augmentation Rhinoplasty With Rib Graft : A Case Report

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Nadia Kusumastuti ◽  
Gentur Sudjatmiko
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Nasal Bone ◽  
Rigid Fixation ◽  
Nasal Deformity ◽  
Cross Sectional ◽  
Alar Base ◽  
Columellar Strut ◽  
Operative Result

Correction of a cleft lip nasal deformity remains a challenging procedure in reconstructive surgery. Many different procedures have been suggested to address the problem, but few techniques have worked well and consistently. We present a case of secondary cleft nasal deformity after repair of unilateral complete cleft lip and palate on the left side. The corrective procedures carried out included closed method rhinoplasty and dorsal nasal augmentation with rib graft which was fixed to the nasal septum with needle. The patient showed satisfactory immediate post-operative result, with correction of depressed alar base and satisfying dorsal and tip projection. However, 5 months post operative result showed deviation of nasal tip to the cleft side, which we suspected was due to: warping of the rib graft, soft tissue deficiency in the cleft side which exerts pulling forces to the warping graft, and lack of rigid fixation of the graft. After appraising pitfalls encountered in augmenting nasal dorsum of cleft patients with rib graft, we concluded that some preventive measures need to be done to avoid those problems, namely: balanced cross sectional carving of rib graft, cantilever graft with plate and screw to the nasal bone, and addressing pulling force from lack of soft tissue in the cleft side by adding columellar strut graft or alar contour graft.

The Effects of Alar Base Augmentation in Secondary Unilateral Cleft Lip Nasal Deformity

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yong Bae Kim ◽  
Seung Min Nam ◽  
Eun Soo Park ◽  
Chang Yong Choi ◽  
Moon Seok Kang ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Nasal Deformity ◽  
Alar Base

Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity

2020 ◽  
Vol 145 (2) ◽  
pp. 458e-460e
Author(s):  
Chad A. Purnell ◽  
Russell E. Ettinger ◽  
Raymond W. Tse
Keyword(s):  
Cleft Lip ◽  
Nasal Deformity ◽  
Optical Illusion ◽  
Alar Base
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