Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete harel ip with design of nasal subunits. Methods From January 2006 to December 2008, 18 patients with nasal deformity after prothesis of unilateral complete harel ip were treated. There were 7 males and 11 femalesaged 6-26 years old. The deformity located on the left side in 11 cases and the right side in 7 cases with major manifestations of deviation and crispation towards normal side of nasal columella, applanation and collapse of nasal ala, lenity and dyssymmetry of nostrils, malposition of basement of nasal ala. Time between harel ip prothesis and secondary epithesis was 4-21 years (average 8 years). During epithesis, nasal columella were extended, collapse nasal alar cartilages were l iberated and fixed in symmetrical positions, injured upper l ip was extended with nasolabial flap or to “tongue-l ike” flap on nasal base. Eleven cases were implanted L-type sil icone prothesis to hump nose. Results For 1 case suffered postoperative rejection, the implant of L-type sil icone prothesis was taken out promptly, and reimplant of prothesis was performed 6 months later without postoperative rejection. The incision of the other patients all healed by first intention without any postoperative compl ications. The effect of epithesis was good with such manifestations as the eminence of injured nasal ala, normal radian, and symmetrical nostils. All patients werefollowed up for 3 months-2 years (average 8 months). The incision was hidden with well-maintained appearance and no obvious scar. Conclusion Based on feature of nasal subunits and formation causes of deformity, individual-orientated epithesis design of nasal ala margin, nasal columella basement incisions, reset and fix nasal alar cartilages and tissues values can provide the patients suffering the secondary nasal deformity with satisfied appearance.
ObjectiveTo explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft.MethodsA retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured.ResultsAll incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no compli cation, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest points of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral points of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation (P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line (P<0.05). No thoracic contour change occurred at the costal cartilage donor site.ConclusionThe thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.
ObjectiveTo evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.MethodsBetween January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).ResultsThe incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.ConclusionAutologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.