Primary repair of unilateral cleft lip nasal deformity

There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome. A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008. Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were perfonned primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages. The average follow up periods were 3 years [ranging from 1-5 years]. The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good resu1ts, 16 patients had acceptable results, and 6 patients had poor results. Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Whether it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question

Septorhinoplasty for the crooked nose

The externally deviated nose represents a complex cosmetic and functional problem. Its correction remains one of the challenging problems in rhinoplasty. To evaluate the result of correction of crooked nose by septorhinoplasty with fixation of nasal septum to the anterior nasal spine. 54 patients have undergone primary septorhinoplasty through a closed approach including full mobilization of the septal cartilage, osteotomy to reduce the displaced lateral nasal wall and finally fixing the septal cartilage to the anterior nasal spine. The minimum follow-up period was 6 months. Recurrence rate for nasal deviation 10%. The aesthetic results were considered good to excellent in all patients, as judged by both the surgeons and patients. Complete mobilization of septal cartilage without scoring along with its fixation to the anterior nasal spine is satisfactory for correcting crooked nose

Closure of A large complicated pharyngocutaneous fistula

Pectoralis major muscle or myocutaneous flap is usually used for closure of big pharyngocutaneous fistula. In case of partial or complete failure, the plastic surgeon should be well prepared to use a second option for closure weather using myocutaneous or fasciocutaneous flaps, alone or with combination. Deepithelialized Deltopectoral flap found to be a reliable option