Web Uni-Limb Z-Plasty for Correction of Alar Web Deformity in Unilateral Cleft Lip Nasal Deformities: Photogrammetric Analysis

PURPOSE: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. METHODS: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. RESULTS: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. CONCLUSION: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

Tripod Framework Rebuilding in Asian Nose: Tip Plasty Using Alar Advancement Technique

In Caucasians, the lateral crural complex is large and long, and the tip plasty is not difficult. In Asians, however, the nasal tissues are insufficient and the nasal tip needs more volume. Therefore, many operators rely on a graft insertion for augmentation effect. Occasionally, if the tip supporting framework is weak, nasal tip drooping is observed by the operators in long period of follow-up. Recently, release and division of tripod structure combined with framework rebuilding has made the correction of various tripod types of tip complexes possible. The main principle of alar advancement technique is that three limbs of the tripod should be properly separated. The nasal tip should be advanced toward upward and forward direction and reinforcement should be done with autologous graft. In other words, scroll ligament, which connects between the alar cartilage and upper lateral cartilage, and nasal hinge complex should be divided freely, inducing the pivot motion and gliding of alar cartilage which leads the V-Y fashioned advancement and projection of alar cartilage. This paper presents an operation method using auricular cartilage after examining the principle of alar advancement in patients who have lack of tip projection, based on my cadaver study and clinical experience.