Long term outcome of columellar lengthening in bilateral cleft lip nose deformity using several methods

ABSTRACT

A typical bilateral cleft lip nose shows a short columella, depressed nasal tip, bilateral dislocation and flaring of alar cartilage, wide alar base and almost no nasolabial angle in profile. Among them, the most conspicuous residual stigmata of the repaired bilateral cleft lip nose deformity is apparently a short columella. The optimal columellar lengthening procedure should be selected according to the particular nasolabial deformity and the age of patient. However, whatever methods are used, it is extremely difficult to produce the natural columellar contour. Among the numerous techniques employed for columellar lengthening. Cronin's method and forked flaps have been widely used. The operation for lengthening the columella can be classified into three groups on the basis of source of material:lip,nose, or ear. Cronin's method is an advancement of skin medially and forward from the floor of the nose and alae on two bipedicle flaps, based medially on the columella and laterally on the alae. But, Cronin's method is rarely sufficient in achieving good nasal projection. Forked flap is a method using vertical scar flaps. It is effective in ways, but the method disturbs the well formed arhitectures of the Cupid's bow and philtral width attained at the primary lip repair, and creates new upper lip scar with adverse effect on upper lip tightness. Columellar composite graft from the helical rim has been used quite effectively, but the curvature and consistency of the conventionally used ear cartilage graft are often inadequate. The author peformed and reviewed the results of the above various techniques of columellar lengthening and found that the various techniques had its own unique disadvantages. So, the author developed a new composite graft that the chondrocutaneous composite graft is harvested from the concha rather than the rim and is folded into a file-folder design. This method allows symmetrical and straight columellar formation with firm and stable support. The author performed this chondrocutaneous composite graft of a file-folder design in our series of 19 patients and the postoperative results were satisfactory in a follow-up period of 12months. This study included 46 cases of bilateral cleft lip nose deformity for the past 10 years from February of 1987 to September of 1997. They consist of 3 cases of Cronin's method, 3 cases of primary forked flap, 17 cases of forked flap, 4 cases of bilateral reverse W-plasty and 19 cases of composite graft of file folder design by author's method. The follow-up period was variable from 1 month to 13 years (mean13 months) and the results of long term follow-up more than 2 years are shown.