Resorbable Plates in Secondary Cleft Nasal Reconstruction

2017 ◽  
Vol 55 (2) ◽  
pp. 226-230
Author(s):  
Pey-Yi Lin ◽  
Anthony P. Gibson ◽  
John F. Teichgraeber ◽  
Matthew R. Greives
Keyword(s):  
Cleft Lip ◽  
Pediatric Population ◽  
Group Versus ◽  
Nasal Reconstruction ◽  
Cartilage Graft ◽  
Nasal Deformity ◽  
Safe Alternative ◽  
Cartilage Grafts ◽  
Plate Group ◽  
Additional Surgery

Objective: The authors report on the use and complications of alloplastic resorbable plates and compare their use to autologous cartilage grafts in secondary cleft nasal reconstruction. Design: Institutional review board (IRB)–approved retrospective chart review. Setting: Texas Cleft-Craniofacial Center at the McGovern Medical School at the University of Texas Health Sciences Center at Houston. Patients: Patients with unilateral or bilateral cleft lip nasal deformity who have undergone secondary correction of their nasal deformity with at least 1-year follow-up. Interventions: During their reconstruction, some patients had cartilage grafts used for support, whereas others were reconstructed using resorbable plates. Main Outcome Measure(s): Complications (exposure, infection, malposition, hematoma/seroma) and rates of tertiary revisions. Results: 197 patients underwent secondary cleft nasal reconstruction, with 30 patients in the resorbable plate group and 32 in the cartilage graft group. Age at surgery was 8.5±4.1 years with resorbable plates and 11.0±4.8 years with cartilage graft ( P = .03). Infection rate in the resorbable plate group and cartilage graft group were 0% and 3.25% ( P = 1). Extrusion occurred in 3 of the absorbable plate group and 2 patients with cartilage graft ( P = .67). Additional surgery was recorded in 43.3% of the resorbable plate group versus 53.1% of the cartilage graft group ( P = .459). Conclusion: The data provide evidence that the use of alloplastic resorbable plate in the pediatric population is a safe alternative to autologous septal cartilage in secondary cleft nasal reconstruction. There is no statistical difference in short-term complications or the incidence of additional nasal surgery.

scholarly journals Composite correction of a unilateral cleft lip nose deformity and alveolar bone grafting

2009 ◽  
Vol 42 (S 01) ◽  
pp. S71-S78
Author(s):  
Nitin J. Mokal ◽  
Chintamani Kale ◽  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Septal Cartilage ◽  
Alar Cartilage ◽  
Open Rhinoplasty ◽  
Cartilage Graft ◽  
Nasal Deformity ◽  
Alveolar Bone Grafting ◽  
Alar Rim

ABSTRACT Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there is no single established universally accepted method of correction. The open alveolar gap and the ipsilateral hypoplastic maxilla are two major problems in achieving consistently good results in a cleft lip nasal deformity. In our study, after first assuring the orthodontic realignment of maxillary arches, we combined bone grafting in the alveolar gap and along the pyriform margin, with a formal open rhinoplasty approach. Methods: All the patients underwent orthodontic treatment for preparation of the alveolar bone grafting. During the process of alveolar bone graft, a strip of septal cartilage graft was harvested from the lower border of the septum which also helps to correct the septal deviation. The cancellous bone graft harvested from the iliac crest was used to fill the alveolar gap and placed along the pyriform margin to gain symmetry. Through open rhinoplasty along the alar rim and additionally using Potter's incision extending to the lateral vestibule, the lateral crura of the alar cartilage on the cleft side was released from its lateral attachment and advanced medially as a chondromucosal flap in a V–Y fashion, in order to bring the cleft-side alar cartilage into a normal symmetric position. The harvested septal cartilage graft was used as a columellar strut. The cleft nostril sill was narrowed by a Y–V advancement at the alar base and any overhanging alar rim skin was carefully excised to achieve symmetry. Results: The results of this composite approach were encouraging in our series of 15 patients with no additional morbidity and a better symmetry of the nose and airway especially in the adolescent age group. Conclusion: This concept of simultaneous approach when appropriate for nasal correction at the time of alveolar bone grafting showed an encouraging aesthetic and functional outcome.

scholarly journals Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

2009 ◽  
Vol 42 (S 01) ◽  
pp. S91-S101
Author(s):  
Mimis Cohen ◽  
David E. Morris ◽  
Aisha D. White ◽  
Pravin Patel
Keyword(s):  
Cleft Lip ◽  
Critical Evaluation ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Long Term Results ◽  
Functional Improvement ◽  
Functional Evaluation ◽  
Nasal Deformity ◽  
Treatment Protocols ◽  
Additional Surgery

ABSTRACTThe treatment of patients with unilateral cleft lip has undergone significant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treatment protocols, and constant striving for perfection in both aesthetics and function, we have been able to design improved treatment strategies and more accurate surgical techniques so as to achieve overall superior and long-lasting results. In this review article, we present our protocols and experience for functional and aesthetic correction of secondary unilateral cleft lip nasal deformities and a retrospective review of 219 consecutive patients treated at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities. The protocols used in the treatment of 219 consecutive patients at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities were reviewed. In addition, analysis of the most recent 51 consecutive patients who underwent complete clinical and functional evaluation with rhinomanometry followed by correction of the cleft lip nasal deformity was performed. A variety of time-honoured techniques of rhinoplasty were applied in the correction of the residual deformities to achieve symmetry, aesthetic balance, and functional correction of the nose. Follow-up ranged from 5-11 years. Analysis of the data revealed that 39 patients (76.47%) had significant functional and aesthetic improvement; seven patients (13.07%) had significant aesthetic improvement but a modest functional improvement; and five patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that five out of seven patients in the second group had pharyngeal flaps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these flaps because the speech was excellent. The surgical plan is based on the information gained from our extensive clinical evaluation and is tailored to the patient's specific functional and aesthetic needs.

Rhinoplasty in unilateral cleft lip nasal deformity

2000 ◽  
Vol 114 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Hossam Foda ◽  
Khaled Bassyouni
Keyword(s):  
Surgical Technique ◽  
Cleft Lip ◽  
Adult Patients ◽  
Nasal Deformity ◽  
Cosmetic Results ◽  
Cartilage Grafts ◽  
Structural Support ◽  
Repair Technique ◽  
External Rhinoplasty

An operation is described for correction of unilateral cleft lip nasal deformity which has had considerable uniformity of success and is applicable to both mild and severe degrees of deformity. Our proposed repair technique is performed through an external rhinoplasty approach and depends on repositioning of the displaced and deformed cartilages together with the reinforcement of the structural support of the nose by using multiple cartilage grafts. This surgical technique was used in 18 consecutive adult patients with unilateral cleft lip nasal deformity and yielded consistently good long-term functional and cosmetic results.

The Effect of Perichondrium and Graft Modification on the Viability of Conchal Cartilage Graft: An Experimental Study in Rabbit

2021 ◽  
pp. 105566562199817
Author(s):  
Nathania Pudya Hapsari ◽  
Kristaninta Bangun ◽  
Parintosa Atmodiwirjo ◽  
Bambang Ponco ◽  
Tri Isyani Tungga Dewi ◽  
...  
Keyword(s):  
Nasal Reconstruction ◽  
Apoptotic Cells ◽  
Cartilage Graft ◽  
Weight Changes ◽  
Cartilage Grafts ◽  
Conchal Cartilage ◽  
Structural Support ◽  
Post Test ◽  
Graft Thickness ◽  
Diced Cartilage

Objective: Cartilage grafts are widely used in reconstructing nasal deformity for structural and aesthetic purposes. Despite being immunologically privileged, cartilage grafts are susceptible to volume loss with high risk of resorption over time. Therefore, experts opt for cartilage handling modification to resolve this issue through graft dicing, wrapping, or perichondrium preservation. This study will evaluate the effect cartilage graft preparations on graft viability. Design: Single-randomized post-test-only study design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Six New Zealand, male, Hycole rabbits. Intervention: Conchal cartilage grafts were retrieved from 6 experimental rabbits and distributed into 3 treatment groups: diced cartilage graft (DC; control), one-sided perichondrium-attached scored cartilage (OPSC), and tube-shaped perichondrium-wrapped diced cartilage (TPDC). Main Outcome Measures: Macroscopic (weight and contour) and microscopic (chondroblast proliferation, graft thickness, apoptotic cells) evaluation through histological measures were recorded on week 12. Statistical analysis was done to compare between groups. Results: Diced cartilage and OPSC groups showed significant weight changes on week 12 ( P < .05) with OPSC presenting with the biggest difference. Diced cartilage and OPSC group showed moderate cell proliferation on week 12 while TPDC displayed most abundant apoptotic cells (5.8%; P < .05). Diced cartilage group had the highest cartilage thickness ratio ( P < .05). Discussion: Bare DC technique promoted graft thickness while perichondrium-attached scored cartilage showed the most abundant chondroblast proliferation and the least apoptotic cells. Perichondrium contributes to enhanced new cartilage formation. Conclusion: Diced cartilage graft is suitable for masking irregularity and volume augmentation, while perichondrium-attached cartilage graft is better for structural support in nasal reconstruction.

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