TY - JOUR
T1 - Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty
T2 - An anthropometric study
AU - Rossell-Perry, Percy
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background: Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities. Methods: A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively. Results: Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively. Conclusions: The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip. Rossell-Perry Percy 1 Post Graduate Studies Department Faculty of Medicine, San Martin de Porres University, Lima, Peru; Outreach Surgical Center, Lima Perú ReSurge International, Sunnyvale, CA 94086, USA Talmant JC, Talmant JC, Lumineau JP. Primary treatment of cleft lip and palate. Its fundamental principles. Ann Chir Plast Esthet 2016;61:348-59. Cronin ED, Rafols FJ, Shayani P, Al-Haj I. Primary cleft nasal repair: The composite V-Y flap with extended mucosal tab. Ann Plast Surg 2004;53:102-8. LaRossa D, Donath G. Primary nasoplasty in unilateral and bilateral cleft nasal deformity. Clin Plast Surg 1993;20:781-91. Narayanan P, Adenwalla H. Primary rhinoplasty at the time of unilateral cleft lip repair: A review and our protocol. J Cleft Lip Palate Craniofacial Anomalies 2015;2:92-7. Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair: A 33-year experience. J Craniofac Surg 2003;14:549-58. Wolfe SA, Nathan NR, MacArthur IR. The cleft lip nose: Primary and secondary treatment. Clin Plast Surg 2016;43:213-21. Thomas C, Mishra P. Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 2000;53:1-6. Potter J. Some nasal tip deformities due to alar cartilage abnormalities. Plast Reconstr Surg 1954;13:358-66. Talmant JC, Talmant JC. Cleft rhinoplasty, from primary to secondary surgery. Ann Chir Plast Esthet 2014;59:555-84. Basta MN, Goldstein JA, Wilson AJ, Taylor JA. A modified V-Y chondromucosal composite flap for correction of secondary cleft nasal deformity: Photogrammetric analysis of a case-control study. Plast Reconstr Surg 2014;134:94-101. Rossell-Perry P, Gavino-Gutierrez AM. Upper double-rotation advancement method for unilateral cleft lip repair of severe forms: Classification and surgical technique. J Craniofac Surg 2011;22:2036-42. Rossell-Perry P. A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique. Indian J Plast Surg 2016;49:340-9. Cutting CB, Dayan JH. Lip height and lip width after extended Mohler unilateral cleft lip repair. Plast Reconstr Surg 2003;111:17-23. Cohen M, Morris DE, White AD, Patel P. Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities. Indian J Plast Surg 2009;42 Suppl S1:91-101. Millard R Jr. A primary camouflage of the unilateral hare-lip. In: Transactions of the International Society of Plastic Surgeons. Baltimore: Williams and Wilkins; 1957. p. 60. Patel KB, Mulliken JB. Correction of the vestibular web during primary repair of unilateral cleft lip. Plast Reconstr Surg 2014;134:600e-7e. van der Heijden P, Dijkstra PU, Stellingsma C, van der Laan BF, Korsten-Meijer AG, Goorhuis-Brouwer SM. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: A call for unified research. Plast Reconstr Surg 2013;131:62e-71e. Levy-Bercowski D, Abreu A, DeLeon E, Looney S, Stockstill J, Weiler M, et al. Complications and solutions in presurgical nasoalveolar molding therapy. Cleft Palate Craniofac J 2009;46:521-8. Uzel A, Alparslan ZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: A systematic review. Cleft Palate Craniofac J 2011;48:587-95. Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac J 2005;42:658-63. Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study. Plast Reconstr Surg 2004;114:858-64. Chang CS, Por YC, Liou EJ, Chang CJ, Chen PK, Noordhoff MS. Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon's experience. Plast Reconstr Surg 2010;126:1276-84. Yoshimura Y, Okumoto T, Iijima Y, Inoue Y. Reduced nasal growth after primary nasal repair combined with cleft lip surgery. J Plast Reconstr Aesthet Surg 2015;68:e159-66. Farouk A. Rhinoplasty in clefts: An 18-year retrospective review. Facial Plast Surg 2015;31:539-52. Kaufman Y, Buchanan EP, Wolfswinkel EM, Weathers WM, Stal S. Cleft nasal deformity and rhinoplasty. Semin Plast Surg 2012;26:184-90.
AB - Background: Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities. Methods: A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively. Results: Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively. Conclusions: The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip. Rossell-Perry Percy 1 Post Graduate Studies Department Faculty of Medicine, San Martin de Porres University, Lima, Peru; Outreach Surgical Center, Lima Perú ReSurge International, Sunnyvale, CA 94086, USA Talmant JC, Talmant JC, Lumineau JP. Primary treatment of cleft lip and palate. Its fundamental principles. Ann Chir Plast Esthet 2016;61:348-59. Cronin ED, Rafols FJ, Shayani P, Al-Haj I. Primary cleft nasal repair: The composite V-Y flap with extended mucosal tab. Ann Plast Surg 2004;53:102-8. LaRossa D, Donath G. Primary nasoplasty in unilateral and bilateral cleft nasal deformity. Clin Plast Surg 1993;20:781-91. Narayanan P, Adenwalla H. Primary rhinoplasty at the time of unilateral cleft lip repair: A review and our protocol. J Cleft Lip Palate Craniofacial Anomalies 2015;2:92-7. Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair: A 33-year experience. J Craniofac Surg 2003;14:549-58. Wolfe SA, Nathan NR, MacArthur IR. The cleft lip nose: Primary and secondary treatment. Clin Plast Surg 2016;43:213-21. Thomas C, Mishra P. Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 2000;53:1-6. Potter J. Some nasal tip deformities due to alar cartilage abnormalities. Plast Reconstr Surg 1954;13:358-66. Talmant JC, Talmant JC. Cleft rhinoplasty, from primary to secondary surgery. Ann Chir Plast Esthet 2014;59:555-84. Basta MN, Goldstein JA, Wilson AJ, Taylor JA. A modified V-Y chondromucosal composite flap for correction of secondary cleft nasal deformity: Photogrammetric analysis of a case-control study. Plast Reconstr Surg 2014;134:94-101. Rossell-Perry P, Gavino-Gutierrez AM. Upper double-rotation advancement method for unilateral cleft lip repair of severe forms: Classification and surgical technique. J Craniofac Surg 2011;22:2036-42. Rossell-Perry P. A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique. Indian J Plast Surg 2016;49:340-9. Cutting CB, Dayan JH. Lip height and lip width after extended Mohler unilateral cleft lip repair. Plast Reconstr Surg 2003;111:17-23. Cohen M, Morris DE, White AD, Patel P. Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities. Indian J Plast Surg 2009;42 Suppl S1:91-101. Millard R Jr. A primary camouflage of the unilateral hare-lip. In: Transactions of the International Society of Plastic Surgeons. Baltimore: Williams and Wilkins; 1957. p. 60. Patel KB, Mulliken JB. Correction of the vestibular web during primary repair of unilateral cleft lip. Plast Reconstr Surg 2014;134:600e-7e. van der Heijden P, Dijkstra PU, Stellingsma C, van der Laan BF, Korsten-Meijer AG, Goorhuis-Brouwer SM. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: A call for unified research. Plast Reconstr Surg 2013;131:62e-71e. Levy-Bercowski D, Abreu A, DeLeon E, Looney S, Stockstill J, Weiler M, et al. Complications and solutions in presurgical nasoalveolar molding therapy. Cleft Palate Craniofac J 2009;46:521-8. Uzel A, Alparslan ZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: A systematic review. Cleft Palate Craniofac J 2011;48:587-95. Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac J 2005;42:658-63. Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study. Plast Reconstr Surg 2004;114:858-64. Chang CS, Por YC, Liou EJ, Chang CJ, Chen PK, Noordhoff MS. Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon's experience. Plast Reconstr Surg 2010;126:1276-84. Yoshimura Y, Okumoto T, Iijima Y, Inoue Y. Reduced nasal growth after primary nasal repair combined with cleft lip surgery. J Plast Reconstr Aesthet Surg 2015;68:e159-66. Farouk A. Rhinoplasty in clefts: An 18-year retrospective review. Facial Plast Surg 2015;31:539-52. Kaufman Y, Buchanan EP, Wolfswinkel EM, Weathers WM, Stal S. Cleft nasal deformity and rhinoplasty. Semin Plast Surg 2012;26:184-90.
KW - Cleft rhinoplasty
KW - nose deformity
KW - unilateral cleft lip
UR - http://www.scopus.com/inward/record.url?scp=85040063436&partnerID=8YFLogxK
U2 - 10.4103/ijps.IJPS_215_16
DO - 10.4103/ijps.IJPS_215_16
M3 - Article
AN - SCOPUS:85040063436
SN - 0970-0358
VL - 50
SP - 180
EP - 186
JO - Indian Journal of Plastic Surgery
JF - Indian Journal of Plastic Surgery
IS - 2
ER -