Skip to main content
Top
Published in: Journal of Maxillofacial and Oral Surgery 4/2023

19-11-2023 | Rhinoplasty | ORIGINAL ARTICLE

Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation

Authors: K. Mustafa, Shehzana Fatima, M. V. Ashith, Jay Nandkishor Goyal, Amrutha Varshini, Aafreen Aftab

Published in: Journal of Maxillofacial and Oral Surgery | Issue 4/2023

Login to get access

Abstract

Introduction

Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success.

Aim

To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip.

Methods

100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard’s rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12 months post-operatively on a 1:1 standard photograph.

Results

Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V.

Conclusion

In our study, group V, i.e., modified Millard’s repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.
Literature
1.
go back to reference Sundine M, Phillips J (2004) Treatment of the unilateral cleft lip nasal deformity. J Craniofac Surg 15(1):69–76CrossRefPubMed Sundine M, Phillips J (2004) Treatment of the unilateral cleft lip nasal deformity. J Craniofac Surg 15(1):69–76CrossRefPubMed
2.
go back to reference Salyer KE, Genecov ER, Genecov DG (2004) Unilateral cleft lip-nose repair—long-term outcome. Clin Plast Surg 31(2):191–208CrossRefPubMed Salyer KE, Genecov ER, Genecov DG (2004) Unilateral cleft lip-nose repair—long-term outcome. Clin Plast Surg 31(2):191–208CrossRefPubMed
3.
go back to reference Arajy ZY, Nawres AM (2009) Primary repair of unilateral cleft lip nasal deformity. Iraqi Postgrad Med J 8(3) Arajy ZY, Nawres AM (2009) Primary repair of unilateral cleft lip nasal deformity. Iraqi Postgrad Med J 8(3)
4.
go back to reference Li AQ et al (2002) Anatomy of the nasal cartilages of the unilateral complete cleft lip nose. Plast Reconstr Surg 109(6):1835–1838CrossRefPubMed Li AQ et al (2002) Anatomy of the nasal cartilages of the unilateral complete cleft lip nose. Plast Reconstr Surg 109(6):1835–1838CrossRefPubMed
5.
go back to reference Demke JC, Tatum SA (2011) Analysis and evolution of rotation principles in unilateral cleft lip repair. J Plast Reconstr Aesthet Surg 64(3):313–318CrossRefPubMed Demke JC, Tatum SA (2011) Analysis and evolution of rotation principles in unilateral cleft lip repair. J Plast Reconstr Aesthet Surg 64(3):313–318CrossRefPubMed
6.
go back to reference Somensi RS, Giancolli AP, Lucenade F (2012) Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique. Rev Bras Cir Plást 27(1):14–21CrossRef Somensi RS, Giancolli AP, Lucenade F (2012) Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique. Rev Bras Cir Plást 27(1):14–21CrossRef
8.
go back to reference Markus AF, Delaire J (1993) Functional primary closure of cleft lip. Br J Oral Maxillofac Surg 31(5):281–291CrossRefPubMed Markus AF, Delaire J (1993) Functional primary closure of cleft lip. Br J Oral Maxillofac Surg 31(5):281–291CrossRefPubMed
9.
go back to reference Gawrych E, Janiszewska-Olszowska J (2011) Primary correction of nasal septal deformity in unilateral clefts during lip repair—a long-term study. Cleft Palate Craniofac J 48(3):293–300CrossRefPubMed Gawrych E, Janiszewska-Olszowska J (2011) Primary correction of nasal septal deformity in unilateral clefts during lip repair—a long-term study. Cleft Palate Craniofac J 48(3):293–300CrossRefPubMed
10.
go back to reference Armstrong GT et al (1997) A modification of the primary nasal correction in the rotation-advancement unilateral cleft lip repair. Ann Plast Surg 38(3):236–245CrossRefPubMed Armstrong GT et al (1997) A modification of the primary nasal correction in the rotation-advancement unilateral cleft lip repair. Ann Plast Surg 38(3):236–245CrossRefPubMed
11.
go back to reference Chow V, Chen P, Noordhoff S (1999) The use of nasal splints in primary management of unilateral cleft nasal deformity. Plast Reconstr Surg 103(5):1347–1354CrossRef Chow V, Chen P, Noordhoff S (1999) The use of nasal splints in primary management of unilateral cleft nasal deformity. Plast Reconstr Surg 103(5):1347–1354CrossRef
12.
go back to reference Thomas C, Mishra P (2000) Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 53(1):1–6CrossRefPubMed Thomas C, Mishra P (2000) Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 53(1):1–6CrossRefPubMed
13.
go back to reference Grayson BH et al (1999) Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 36(6):486–498CrossRefPubMed Grayson BH et al (1999) Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 36(6):486–498CrossRefPubMed
14.
go back to reference Barillas I et al (2009) Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip–cleft palate patients. Plast Reconstr Surg 123(3):1002–1006CrossRefPubMed Barillas I et al (2009) Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip–cleft palate patients. Plast Reconstr Surg 123(3):1002–1006CrossRefPubMed
15.
go back to reference Matsuo K, Hirose T (1991) Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 44(1):5–11CrossRefPubMed Matsuo K, Hirose T (1991) Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 44(1):5–11CrossRefPubMed
16.
go back to reference Nakajima T, Yoshimura Y, Sakakibara A (1990) Augmentation of the nostril splint for retaining the corrected contour of the cleft lip nose. Plast Reconstr Surg 85(2):182–186CrossRefPubMed Nakajima T, Yoshimura Y, Sakakibara A (1990) Augmentation of the nostril splint for retaining the corrected contour of the cleft lip nose. Plast Reconstr Surg 85(2):182–186CrossRefPubMed
17.
go back to reference Tse R (2013) Unilateral cleft lip: principles and practice of surgical management. Semin Plast Surg 26(04):145–155CrossRef Tse R (2013) Unilateral cleft lip: principles and practice of surgical management. Semin Plast Surg 26(04):145–155CrossRef
18.
go back to reference Raymond B, Sudjatmiko G (1970) Self made nostril retainer. Jurnal Plastik Rekonstruksi 1(2) Raymond B, Sudjatmiko G (1970) Self made nostril retainer. Jurnal Plastik Rekonstruksi 1(2)
19.
go back to reference Dhanraj P (1994) The use of a suction tube as a nostril retainer. Plast Reconstr Surg 93(3):643–644CrossRefPubMed Dhanraj P (1994) The use of a suction tube as a nostril retainer. Plast Reconstr Surg 93(3):643–644CrossRefPubMed
20.
go back to reference Ozgur F, Tuncali D, Kayýkcýoglu A (1999) Securing the nostril retainer. Plast Reconstr Surg 104:1328CrossRef Ozgur F, Tuncali D, Kayýkcýoglu A (1999) Securing the nostril retainer. Plast Reconstr Surg 104:1328CrossRef
21.
go back to reference Li J et al (2011) A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients. J Plast Reconstr Aesthet Surg 64(11):1436–1443CrossRefPubMed Li J et al (2011) A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients. J Plast Reconstr Aesthet Surg 64(11):1436–1443CrossRefPubMed
22.
go back to reference Pai BCJ et al (2005) Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 42(6):658–663CrossRefPubMed Pai BCJ et al (2005) Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 42(6):658–663CrossRefPubMed
Metadata
Title
Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation
Authors
K. Mustafa
Shehzana Fatima
M. V. Ashith
Jay Nandkishor Goyal
Amrutha Varshini
Aafreen Aftab
Publication date
19-11-2023
Publisher
Springer India
Published in
Journal of Maxillofacial and Oral Surgery / Issue 4/2023
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI
https://doi.org/10.1007/s12663-023-02039-7

Other articles of this Issue 4/2023

Journal of Maxillofacial and Oral Surgery 4/2023 Go to the issue