Total En Bloc Reconstruction of Alar Cartilage with Conchal Cartilage in Seconday Cleft Lip Nasal Deformity

ABSTRACT

The cleft lip nasal deformity includes not only distorted lower lateral cartilage but generally also an abnormal deficient maxillary bony platform as well as distorted anterior nasal spine and deviated nasal septum. The main defect in the nose is in the position and shape of lower lateral cartilage. There were many literatures for modification of alar cartilage for nasal symmetry in the past several decades, that is, relocation, suture fixation and graft augmentation with deformed alar cartilage itself. But the various corrective techniques were unsatisfactory for both surgeons and patients. The purpose of this article is to present new concepts and surgical techniques. Author's basic concept is total replacement of deformed alar cartilage with new sources of contoured alar cartilage. The grafts were taken from conchal cartilage en bloc. The medial crus, dome, and lateral crus were replaced by the lamina tragi, isthmus and cavum conchae, respectively. The unilateral secondary cleft lip and nose deformity patients were reviewed with charts and photographs from 1991 to 1998. The surgical procedures were open rhinoplasty incision technique with reversed U-incision of nostril web and wide undermining of cartilaginous vault. The total en bloc reconstruction technique has been performed for 125 patients, aged from 5 to 40 years, and they were followed up for 6 months to 8 years. There were no surgical complications and donor site morbidities. There were no relapse and growth disturbance over time. The postoperative results showed symmetry of alar unit, alar dome projection, tip-defining points and nostrils. CONCLUSION: A new technique is described for sensational improvement of the nasal esthetics in secondary cleft lip nasal deformity by using an en bloc autogenous conchal cartilage graft. But further observation is needed for evaluating its effect on the long-term growth potentials.