Alar vestibular advancement flap in management of cleft nose deformity

ABSTRACT

The cleft lip nasal deformity presents a challenge for the rhinoplastic surgeons due to three main reasons; the surgical scarring from previous surgical reconstructive attempts, the congenital anatomic deficiency, and growth changes to the size and extent of the deformity. Many techniques have been described to address this problem. Most of the described techniques attempt to manage some aspects of the cleft deformities, however complete correction of all nasal deformities remains a remote goal. The aim of the present work was to evaluate the lateral alar vestibular advancement flap in correcting the cleft nose deformity. 9 patients with a unilateral cleft nose-lip deformity who underwent a previous operation to repair their cleft Lip early in there lives were included in the present study. The Laterally based alar-vestibular advancement flap technique was performed on all of them with the necessary work on the lower lateral and septal cartilages to attain a better looking cartilaginous framework of the lower third of the nose in order to correct the cleft nose deformity. Patients and surgeon's satisfaction is recorded for all surgeries one week and three months postoperative. 8 patients [%88.9], recorded full satisfaction with the surgery outcome and one patient [%11.1] was unsatisfied and needed a second surgery 6 months later to insert a shield graft to camouflage a minor tip asymmetry. The laterally based alar-vestibulatr advancement flap approach utilizes many of the known cleft nose rhinoplasty procedures into a single more universal technique. Using this approach with the open rhinoplasty techniques, stability and symmetry of the nasal tip could be achieved