Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N.

Size: px
Start display at page:

Download "Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N."

Transcription

1 CME Cleft Rhinoplasty Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. Edina and Minneapolis, Minn. Learning Objectives: After studying this article, the participant should be able to: 1. Describe features of the unilateral and bilateral cleft nasal deformities and associated growth changes. 2. Assess the extent of cleft nasal deformity. 3. Recognize current trends and principles of cleft nasal reconstruction. 4. Recognize differences in primary versus secondary cleft nasal correction. Reconstruction of the cleft nasal deformity can often pose a significant challenge to a rhinoplasty surgeon. Principal features of unilateral and bilateral cleft nasal deformities and their changes with growth are discussed. This article reviews current trends in cleft nasal rhinoplasty associated with early and late intervention. Finally, the authors review their own data on the applications of what are deemed current trends in reconstructive rhinoplasty associated with cleft deformities. (Plast. Reconstr. Surg. 114: 57e, 2004.) The three-dimensional combination of rigid skeletal, firm cartilaginous, and plastic skin cover makes the nose a unique part of one s facial appearance. The nose has become a frequently adjusted, reconstructed, enhanced, and even pierced part of the human anatomy. Volumes have been scribed about the complicated anatomy and how it can be adjusted to enhance appearance or function. A nose altered radically by a congenital defect has a major impact on both appearance and function. Rhinoplasty is a challenging surgical procedure, and alteration of the three-dimensional aspects of the nose created by congenital changes will challenge the surgeon s skill and judgment. Features of unilateral and bilateral cleft nasal deformities, growth changes, and assessment methods are discussed. We review current trends in cleft nasal rhinoplasty associated with both early and secondary intervention. Our data on the applications of what are deemed current trends in reconstructive rhinoplasty of cleft deformities are reviewed. FEATURES OF UNILATERAL AND BILATERAL CLEFT NASAL DEFORMITIES Infants presenting with a unilateral cleft lip (Figs. 1 and 2) have inferior and wide lateral displacement of the lower lateral cartilages. The nasal vestibule volume is increased on the cleft side. The often-shortened columella is displaced toward the cleft. The associated horizontal and vertical displacement of the nostril s lower lateral cartilages makes consideration of the lower lateral cartilages an integral part of primary lip repair. However, controversy exists regarding direct lower lateral cartilage manipulations during primary lip repair in infants. FIG. 1. Displacement of the lower lateral cartilage and loss of skeletal foundation are the key features of the unilateral cleft deformity. Received for publication February 3, 2003; revised May 15, DOI: /01.PRS BF 57e

2 58e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 2. Abnormalities associated with bilateral cleft nasal deformity before the authors surgical intervention when the patient was 6 years old and after further correction at age 14. The Abbé flap and tip reconstruction were performed in the interval. FIG. 3. Preoperative lateral views of the same patient shown in Figure 2. The bilateral cleft presents with even more distortion of the nose. A short or near-absent columella, widely displaced lower lateral cartilages, a protuberant or even horizontal premaxilla, and collapse of the maxillary arch behind the premaxilla are all noted in Figures 3 and 4. EFFECTS OF GROWTH ON CLEFT FEATURES Characteristic alterations of appearance and anatomy associated with cleft nasal deformity after facial growth are shown from various perspectives. From the frontal perspective (Fig. 5), one can see a twisted nose, a wide nasal base, flared nostrils, oblique tip-defining points, and asymmetrical columellar alar angles. From the lateral perspective (Fig. 6), one can see altered columellar show, poor tip projection, rhinion prominence, an obtuse nasal labial angle, and short nasal length. From the caudal perspective (Fig. 7), one can see a lateral alar web, asymmetrical lower lateral cartilages and nostrils, columellar scarring, a displaced caudal septum, abnormal hair location, and blunt angulation of the intermediate crus lower lateral cartilage. Columellar show may be increased or decreased from the usual 3 to 5 mm noted in adolescents and adults. A decrease occurs when the lower lateral cartilage is flared and

3 Vol. 114, No. 4 / CLEFT RHINOPLASTY 59e FIG. 4. Inferior view of a 6-year-old patient with lower lateral cartilage collapse associated with cleft nasal deformity. FIG. 6. Diagram for documenting abnormalities, sketch planning, and educating patients and parents. FIG. 5. Inferior view of abnormalities associated with cleft nasal deformity in a 6-year-old patient. LLC, lower lateral cartilage. displaced inferiorly. An increase may occur because of a buckle or notch effect on the lower lateral cartilage from primary rhinoplasty adjustment of the nose or if lower lateral cartilage is not modified during the acute repair. It may even persist despite further attempts at correction (Fig. 8). Tip projection is reduced because the lower lateral cartilage displacement on the cleft side results in lack of support for tip projection against the shortened columellar skin envelope and lateral displacement. Lack of midline alignment of structures is common in unilateral and bilateral clefting. The central incisors, philtrum, and columella may not be aligned in the midline and may not be able to be aligned because of the consequences of the maxillary defect and lip repair qualities. This makes it difficult to put the facial elements into the usual spatial alignment that the mind is accustomed to visualizing. Add to this dilemma a lip repair that does not have horizontal alignment of Cupid s bow peaks and the task of formulating a rhinoplasty plan becomes daunting. DEFORMITY ASSESSMENT Determining the most effective surgical plan for any rhinoplasty must begin with an assessment of the internal nasal structures and their changes (Fig. 9). The following are important issues to be answered during the examination: Is the septum attached or displaced off the crest of the vomer?

4 60e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 9. Appearance of unilateral cleft lip deformity. FIG. 7. Measurements of the nasal dimensions help with perceptions and planning. FIG. 8. When planning correction, perceive where the tipdefining points would be located on the displaced lower lateral cartilage. This is the key to accurate suture placement in early repairs. Is the caudal septum attached to the nasal spine or is it deflected into the nostril aperture? Is the middle portion of the cartilaginous quadrilateral plate deformed? What is the status of the inferior turbinates? Will they obstruct airflow if nasal volume decreases? Is the floor of the nasal vestibule obstructed with exophytic scar from palate closure or bone grafting? Has a pharyngeal flap or sphincteroplasty been performed and does it impede airflow through the nose? Is nasal and sinus mucous drainage adequate? Is breathing at rest oral, nasal, or both? What occurs when exercising? Is sleep apnea a problem? 1 4 Assessment of the external appearance by measurements and observation is important when constructing a surgical plan. To assist in surgical planning, measurements are recorded (Fig. 10) and then repeated postoperatively to assess progress, growth, and results. These numerical data are used to plan surgery and promote thoroughness. There is an art to studying facial characteristics and understanding the three-dimensional relationships that are normal and attractive. Altering those relationships while attempting to improve form or function is a complex combination of the art and science of plastic surgery. 5 Actual measurements help begin the process of planning. How far does the lower lateral cartilage have to be positioned to be similar to the contralateral side both across the base and from the frontal perspective? How deep is the concavity in the sill because of muscle paucity or skeletal deficiency? If the septum is deflected, where should it be positioned and anchored? Are the medial crura of the lower lateral cartilage curved into the naris aperture and are they symmetrical? The measurements and answers that are obtained will serve as a guide in estimating how

5 Vol. 114, No. 4 / CLEFT RHINOPLASTY 61e FIG. 12. Humby provided support for the displaced lower lateral cartilage by using the cephalic excess of the contralateral lower lateral cartilage for support. FIG. 10. Skeletal and muscle deficits, a protruding maxilla, and a short columella are major abnormalities associated with the bilateral cleft deformity. much length and tip support can be created by plicating lower lateral cartilages to each other or to a columellar strut graft (Fig. 11). EVOLVING CONSENSUS Many techniques 1,5 8 have been advocated for attaching the lower lateral cartilages to each other or to the upper lateral cartilages (Figs. 12 through 18). Results in follow-up reports indicate that those techniques, while seemingly satisfactory initially, provided an inadequate correction with growth and time and required additional reconstruction. The common feature seemed to be tip definition and FIG. 13. Walter utilized Humby s concept but also used the ipsilateral cephalic excess of the lower lateral cartilage (LLC) to lengthen the nasal dorsum. He realized that an excessively obtuse nasal labial angle could be corrected by lengthening the nasal dorsum. FIG. 11. Skoog sutured the lower lateral cartilage to the upper lateral cartilage for support of the displaced lower lateral cartilage. lower lateral cartilage collapse because of a lack of persistent tip support Plication of the medial and intermediate crura of the lower lateral cartilages was advocated by Converse in 1964 (Fig. 19). Converse was surely attempting to gain symmetry and support. Rigid columellar support was not provided, so correction relied on the contralateral lower lateral cartilage for enough support to maintain position and projection. Millard believed inadequate skin cover was the dominant issue. In some cases, however, he must have believed that lower lateral cartilage support was also insufficient to maintain

6 62e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 14. Byars divided the ipsilateral medial crus and used it to elevate the lower lateral cartilage. It also reduced support for the nasal tip provided by the medial crura of the lower lateral cartilage. shape, as he advocated placing unsecured struts of cartilage between the medial crura to provide more support for the lower lateral cartilages in some of his patients. Another vexing issue is the web created in the lateral vestibule of the nose (Fig. 20). It is created by the displaced lateral crura of the lower lateral cartilage being brought to a more medial position and also by additional connective tissue between the lower lateral cartilage and overlying skin. Z-plasties, V-Y advancements, and flap rotations usually do not completely correct the web, and over the long term they may constrict the nasal vestibule or nostril and require a secondary correction. 13,14 With that history as the background, surgeons realized that skin and soft-tissue alterations for many patients did not provide longterm correction against the relentless resistance of deformed skeletal and cartilaginous structures associated with clefts. That recognition heralded a new era of reconstruction in the 1990s that was initiated by many different authors within a similar time period. 2,12,14 18 The concepts now applied are early intervention, strong columellar support for nasal tip projection, and construction of a nasal framework that mimics the appearance, symmetry, and position of a normal lower lateral cartilage FIG. 15. Erich gained access to the nasal structures by using an open rhinoplasty technique. (Fig. 21). After a strong framework is reconstructed, skin cover can be adjusted so that it contours around the new lower lateral cartilage framework. That change in planning produced improved results in the appearance of the reconstructed cleft nasal deformity. Many authors 2,16,17,19 believe that correcting the displaced framework structures at the time of the initial lip repair is desirable (Figs. 22 through 24). Critics were fearful that early adjustment of nasal cartilage structures would produce growth discrepancies. Adequate periods of follow-up have shown that the nose does grow normally after early adjustment of position and configuration of the cartilaginous portions of the nose. The methods of adjusting the nose during primary cleft lip repair (Figs. 25 through 27) seem to have a few basic goals: (1) to provide tip support by suturing the lower lateral cartilages to each other and to the upper lateral cartilages; (2) to stabilize the abnormal lower lateral cartilage in a more anatomic and symmetrical position 18 ; (3) to establish a muscle and soft-tissue sill across the nasal base 20 ; and (4) to correct the webbed lateral alar mucosa by plicating skin and mucosa. 7 Early intervention and adjustment of the lower lateral cartilages in the cleft nose is ben-

7 Vol. 114, No. 4 / CLEFT RHINOPLASTY 63e FIG. 17. Tajima achieved additional ipsilateral lower lateral cartilage elevation by suturing the lower lateral cartilage to the contralateral upper lateral cartilage. FIG. 16. Trott s approach. eficial, but this approach usually does not prevent secondary reconstruction when the adult characteristics of the nose become apparent. 11,21 Another concern is that early intervention can make secondary procedures more difficult because of scarring or damage to the lower lateral cartilage from dissection or sutures associated with immediate intervention. AUTHORS DATA AND RECOMMENDATIONS We have reviewed available data from 21 cleft nasal reconstructions performed by the senior author during the past 4 years. The amount of change achieved between preoperative and postoperative measurements and the incidence of some of the techniques used are listed in Tables I and II, respectively. In this series of patients, most cleft lip primary repairs were performed by other surgeons and primary adjustment of the lower lateral cartilage was not done. Often a tip FIG. 18. Tajima realized the asymmetry of the nostril needed to be addressed; the reverse-u flap added another dimension to planning. rhinoplasty was performed by the same surgeon when the patient was of preschool age. At secondary rhinoplasty performed by the authors, these patients were often found to have disrupted intermediate crura, greatly altered anatomy of the lower lateral cartilages, and visible nasal scars. These circumstances significantly complicated their definitive nasal reconstruction and statistical assessment. In this series of patients, the most definitive correction and the calculated mean measurements for each category are shown in Table I. Presently, the principles most often applied involved placing a columellar strut graft, using spanning sutures, bone grafting the maxillary defect, and using mucosal and skin-plicating sutures (Fig. 27). Because the characteristics and size of the lip and nose change in proportion to age, plan-

8 64e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 19. Converse and Millard clearly understood the need for producing lower lateral cartilage symmetry and support for tip projection. Millard added unsecured struts of cartilage between the medial crura for lower lateral cartilage support. FIG. 21. In establishing symmetrical tip-defining points, a secured columellar cartilage graft is used for reinforced support to maintain projection while skin adaptation occurs. FIG. 20. The alar web created in the cleft nose is a persistent problem. TDP, tip-defining point. ning for shape and size is essential during the ages of 8 of 14 years (Fig. 28). Our surgical corrections usually occur at two or three different time intervals. In early infancy, adjustments of the lower lateral cartilages occur in conjunction with the cleft lip repair. Secondary adjustment of the lower lateral cartilages occurs between the ages of 5 and 8 years because of significant distortion of the nasal tip s shape. The final correction occurs when the nose has reached its nearly adult shape, when the patient is between 12 and 15 years of age. The bilateral defects usually require three procedures, whereas unilateral deformities usually require only two adjustments of the nose. These principles have been used to successfully manage early and late cleft nasal deformities associated with unilateral and bilateral cleft repairs. Although controversy still persists, early intervention in skilled hands may make FIG. 22. Byrd s technique for primary nasal intervention. secondary management of the cleft nose deformity easier. It is emphasized that manipulating the lower lateral cartilages during primary lip repair requires technical expertise, loupe magnification, and an understanding of the premaxilla segment and protection of its vascular anatomy. 22 Pediatric anesthesiologists, understanding parents, patient support groups, cleft team involvement, and parent education about the cleft team s long-term plans are important adjuncts to providing parents with confidence and satisfaction. PRIMARY CLEFT NASAL REPAIR TECHNIQUE We prefer to perform adjustments of the lower lateral cartilages during lip repair by using a lateral rim incision patterned after a modified open incision 23 (Fig. 29). The lower lateral cartilages are visualized and the perceived intermediate crus apices are marked with methylene blue dye as reference points. The

9 Vol. 114, No. 4 / CLEFT RHINOPLASTY FIG. 23. Salyer and Kirschbaum both advocated early intervention with alteration of lower lateral cartilage position. Salyer realized the value of plication to prevent web formation and buckling of the lower lateral cartilage. intermediate portions of the lower lateral cartilages are then plicated together with polydioxanone suture to produce symmetry. A suture is placed joining the left and right medial crura s junction with the left and right intermediate crura. An interdomal suture is placed to bring the genu of the two intermediate crura together. The tissue attachments to the flared ala are released, and the lateral ligament-like attachment and associated muscle are preserved. Byrd and Salomon 20 advocate bringing some of the muscle from the lateral lip segment with the lateral component of the lower lateral cartilage and attaching it to the columella. As an extension of Farrior s technique, 18 we prefer to fix the lower lateral cartilage lateral crura across the midline through the premaxilla area to the contralateral alar base with a spanning-type suture (Fig. 26). Using this maneuver, the connective tissue attached to the lower lateral cartilage is still sutured to the midline but without tension. Adjusting this suture tension also supports the cleft repair and narrows the nasal base. This exerts pressure across the entire base of the nose rather than against the already displaced maxillary midline components. It also tends to level the horizontal position of the nasal base and has less potential of interfering with the premaxilla s circulation. After the released lateral alar ligament is reattached across the midline to the contralateral alar base, if buckling or irregularity occurs in the lower lateral cartilage, additional tip projection support or lower lateral cartilage repositioning may be required. To reposition the lower lateral cartilages symmetrically within the skin envelope and to hold them in position when nasal mucosa incisions are closed, the cartilage is included in the mucosal closure. Transcutaneous plicating sutures can be used to position the cartilages if positioning cannot be accurately accomplished when the mucosa incisions are closed. 2 If necessary, the upper lip skin under the nostril can be deepithelialized and the nostril can be reinset to establish symmetry with the contralateral nostril. Since the lower lateral cartilages have been found to be nearly symmetrical in shape, 24 though displaced, in our opinion, resecting or moving portions of the lower lateral cartilage should be delayed until definitive reconstructive rhinoplasty is performed. Initial management of the lower lateral cartilage components may decrease the need for early secondary surgical correction of the lower lateral cartilages in the unilateral cleft nasal deformity. However, despite early intervention in the bilateral cleft at the time of the lip repair, lack of tip projection, an associated short columella, and displaced lower lateral cartilages often result in secondary surgical intervention when the patient reaches preschool age. SECONDARY CLEFT NASAL REPAIR TECHNIQUE 65e In our experience, the most difficult of all rhinoplasties is correction of the bilateral cleft nasal deformity with short nasal projection and an obtuse nasal labial angle. Plication of the intermediate crura concomitant with the lip repair does not provide tip support to overcome the short columellar length, and plication of the lower lateral cartilages does not provide enough projection. Supporting the lower lateral cartilages by suturing them to the upper lateral cartilages has been demonstrated to have only short-term benefit; this approach does not provide adequate projection and contributes to an obtuse nasal labial angle. Secondary columellar lengthening by manipulations of the skin envelope of the nose fails because the skin cannot, over the long term, hold shape against rigid distortion of the displaced underlying lower lateral cartilages. Eventually, carti-

10 66e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 24. Summation of technical points advocated by many authors. FIG. 25. Tip grafts to the caudal area of the intermediate segment of the lower lateral cartilage are placed for tip definition during the final stage of reconstruction. lage determines the skin s shape because of stress relaxation of the skin around the unsupported cartilage framework. In tip rhinoplasty correction performed at preschool age, a modified open technique is used to provide access (Fig. 29). The lower lateral cartilages are adjusted with interdomal and/or intradomal sutures. In the bilateral cleft, skin is recruited from the nasal dorsum and the nostril is pushed to a new position with a rigid cartilage strut graft secured with sutures between the medial crura of the lower lateral cartilages. The strut is then attached to the FIG. 26. Three-dimensional illustration of the authors preferred technique in the final stages of reconstruction. caudal portion of the septum as a batten-type graft to lengthen the nose, or to the posterior septum in the vicinity of the nasal spine if only projection is required. The strut is taken from sources other than the septum and is used to hold the intermediate crus in a projecting po-

11 Vol. 114, No. 4 / CLEFT RHINOPLASTY FIG. 27. Three-dimensional illustration of the authors preferred technique for maintaining lateral vestibule volume and shape. BG, bone graft. TABLE I Preoperative and Postoperative Measurements Before Surgery After Surgery Base width Columellar projection Tip width Nasal labial angle increase Nasal labial angle decrease 12 TABLE II Incidence of Techniques Technique No. of Cases Columellar strut 20/21 (95%) Nasal tip 19/21 (90%) Spreader 5/21 (24%) Onlay/batten 4/21 (19%) Alar wedge resected 8/21 (38%) sition to help adjust the nasal labial angle and nasal length. After the strut is secured, the lower lateral cartilage immediately becomes elongated and maintains that position long term. Tip definition is adjusted using domal sutures supported by the columellar strut graft. Initially, the projection will be prominent. After the adult characteristics and size of the nose are expressed, tip projection may be slightly inadequate. At that time, additional tip support is provided by placing septal grafts on the caudal side of the intermediate crura of the lower lateral cartilage. Using this technique, no decrease in growth of the lower lateral cartilages has been noted, 67e but in bilateral cleft rhinoplasty patients, revision and additional tip projection support are required when they reach the teenage years. At present, we have not used a bioabsorbable device in place of cartilage, but such a device can be an alternative strut if it can provide support long enough to permit the redraping of skin to accommodate the nasal framework. 25 RECOMMENDED SURGICAL MANAGEMENT AT AGE 12 TO 14 YEARS In all of our cleft patients, the final adjustments in nasal reconstruction occurred either when the patient was as a teenager or later in life. 26 The final rhinoplasty is done through an open approach (Fig. 30). The lower lateral cartilages, which are often surrounded by scar, must be carefully visualized. Septal abnormalities are corrected. After any required adjustments in the nasal dorsum, septal cartilage can be obtained for use during reconstruction of the nose. Other sources of graft material are the rib, ear, skull, and ilium The nasal labial angle can be decreased by using a caudal tip graft or, in extreme cases, by extending the septum with batten-type grafts fixed to the cephalic edge of the medial crura (Fig. 31). The cephalic portions of the lower lateral cartilages have also been used for this purpose (Fig. 14). Symmetrical lower lateral cartilages are created by using a combination of intradomal and interdomal sutures and spanning sutures. Direct adjustment of the caudal border of the lower lateral cartilages is occasionally helpful. 30,31 Osteotomies of the nasal pyramid will be required to correct the crooked nose defect if the deviation begins at the nasion. Osteotomy may not be required if the crooked nose deflection begins at the rhinion. 32 Osteotomy may be required when the nasal pyramid is wide and if the nasal dorsum is excessively prominent and requires reduction. The lateral alar web can be corrected by thinning the thickened lateral nasal wall and plicating the mucosa to the skin and to the adjacent piriform margin (Fig. 28). Repositioning of the nostril on the upper lips to match the position, width, and shape of the contralateral lower lateral cartilage can be achieved by deepithelializing the symmetrically determined location on the skin and reinsetting the ala. If buckling of the lower lateral cartilage persists after columellar support has been provided, it is possible to correct this using

12 68e PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2004 FIG. 28. The slow but relentless changes in proportions and structural shape during growth must be considered during planning. FIG. 29. Dotted lines represent intranasal incisions and solid lines represent visualized incisions. FIG. 31. In severe bilateral cleft nasal deformity, the nasal dorsum and columella are short with a very obtuse nasal labial angle. Tip projection and support are essential, but to prevent the obtuse angle, the nasal dorsum must be lengthened. Expanding on Walter s technique, batten grafts are very helpful with correction. is difficult and has the same potential complications as noncleft rhinoplasty. 34 FIG. 30. During open rhinoplasty, a transcolumellar incision is used. Planning that incision is essential. Often a prior incision may exist on the columella, and vascular compromise of the elevated columellar skin can occur if scars compromise the base of the flap. narrow strips of cartilage 33 placed and sutured adjacent to the rim margin to smooth the deformity. Reconstruction of the cleft nasal deformity SUMMARY The principles delineated for correction of the cleft nasal deformity are emphasized in great detail. These principles apply to both unilateral and bilateral deformities. A reconstructed, sturdy framework that has the desired three-dimensional qualities of a normal nose will produce a dramatic change in the shape, function, and appearance of the nose. Nasal function, symmetry, projection, length, width, and tip definition are the goals of the rhino-

13 Vol. 114, No. 4 / CLEFT RHINOPLASTY plasty surgeon. Those goals are also now obtainable in individuals with severe cleft nasal deformity by applying the principles developed over the past decades. 5,35,36 Allen L. Van Beek, M.D France Avenue South Edina, Minn e REFERENCES 1. Millard, D. R. Cleft Craft: Vol. 2, Bilateral and Rare Deformities, 1st Ed. Boston, Mass.: Little, Brown, Salyer, K. E. Early and late treatment of unilateral cleft nasal deformity. Cleft Palate Craniofac. J. 29: 556, Fisher, D. M., and Mann, R. J. A model for the cleft lip nasal deformity. Plast. Reconstr. Surg. 101: 1448, Ellis, D. A., and Gilbert, R. W. Analysis and correction of the crooked nose. J. Otolaryngol. 20: 14, Randall, P. History of cleft lip nasal repair. Cleft Palate Craniofac. J. 29: 527, Cook, T. A., Davis, R. E., and Israel, J. M. The extended Skoog technique for repair of the unilateral cleft lip and nose deformity. Facial Plast. Surg. 9: 195, Tajima, S. Follow-up results of the unilateral primary cleft lip operation with special reference to primary nasal correction by the author s method. Facial Plast. Surg. 7: 97, Converse, J. M., Hogan, V. M., and Barton, F. E. Secondary deformities of cleft lip, cleft lip and nose, and cleft palate. In J. M. Converse (Ed.), Reconstructive Plastic Surgery, Vol. 4, 2nd Ed. Philadelphia, Pa.: Saunders, 1977, Pp Coghlan, B. A., and Boorman, J. G. Objective evaluation of the Tajima secondary cleft lip nose correction. Br. J. Plast. Surg. 49: 457, Cho, B. C., and Baik, B. S. Correction of cleft lip nasal deformity in Orientals using a refined reverse-u incision and V-Y plasty. Br. J. Plast. Surg. 54: 588, Kane, A. A., Pilgram, T. K., Moshiri, M., and Marsh, J. L. Long-term outcome of cleft lip nasal reconstruction in childhood. Plast. Reconstr. Surg. 105: 1600, Mulliken, J. B. Correction of the bilateral cleft lip nasal deformity: Evolution of a surgical concept. Cleft Palate Craniofac. J. 29: 540, Morselli, P. G. The anchor of the nasal ala in cleft lip-nose patients: A morphological description and a new surgical approach. Cleft Palate Craniofac. J. 37: 130, Kirschbaum, J. D., and Kirschbaum, C. A. The chondromucosal sleeve for the unilateral cleft lip nasal deformity. Ann. Plast. Surg. 29: 402, Walter, C. Nasal deformities in cleft lip cases. Facial Plast. Surg. 11: 169, Trott, J. A., and Mohan, N. A preliminary report on open tip rhinoplasty at the time of lip repair in unilateral cleft lip and palate: The Alor Setar experience. Br. J. Plast. Surg. 46: 363, Trott, J. A., and Mohan, N. A preliminary report on one stage open tip rhinoplasty at the time of the lip repair in bilateral cleft lip and palate: The Alor Setar experience. Br. J. Plast. Surg. 46: 215, Farrior, R. T. The cleft lip nose: An update. Facial Plast. Surg. 9: 241, Mulliken, J. B. Primary repair of bilateral cleft lip and nasal deformity. Plast. Reconstr. Surg. 108: 181, Byrd, H. S., and Salomon, J. Primary correction of the unilateral cleft nasal deformity. Plast. Reconstr. Surg. 106: 1276, Habel, G. Repair of unilateral and bilateral cleft noses: An experience of 103 cases. Ann. R. Australas. Coll. Dent. Surg. 11: 259, Ersek, R. A. Necrosis of the nasal tip. Plast. Reconstr. Surg. 97: 491, Holmstrom, H., and Luzi, F. Open rhinoplasty without transcolumellar incision. Plast. Reconstr. Surg. 97: 321, Park, B. Y., Lew, D. H., and Lee, Y. H. A comparative study of the lateral crus of alar cartilages in unilateral cleft lip nasal deformity. Plast. Reconstr. Surg. 101: 915, Stal, S., and Hollier, L. The use of resorbable spacers for nasal spreader grafts. Plast. Reconstr. Surg. 106: 922, Marsch, J. L. When is enough enough? Secondary surgery for cleft lip and palate patients. Clin. Plast. Surg. 17: 37, Ortiz Monasterio, F., and Ruas, E. J. Cleft lip rhinoplasty: The role of bone and cartilage grafts. Clin. Plast. Surg. 16: 177, Celik, M., and Tuncer, S. Nasal reconstruction using both cranial bone and ear cartilage. Plast. Reconstr. Surg. 105: 1624, Takato, T., Harii, K., Yonehara, Y., Komuro, Y., Susami, T., and Uoshima, K. Correction of the cleft nasal deformity with an L-shaped iliac bone graft. Ann. Plast. Surg. 33: 486, Foda, H. M., and Bassyouni, K. Rhinoplasty in unilateral cleft lip nasal deformity. J. Laryngol. Otol. 114: 189, Ellenbogen, R., and Blome, D. W. Alar rim raising. Plast. Reconstr. Surg. 90: 28, Thatte, R. L., Deshpande, S. N., and Thatte, M. R. A radical approach in the treatment of the deviated nose. Br. J. Plast. Surg. 43: 596, Gunter, J. P., Rohrich, R. J., and Friedman, R. M. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast. Reconstr. Surg. 97: 643, Tardy, M. E., Cheng, E. Y., and Jernstrom, V. Misadventures in nasal tip surgery. Otolaryngol. Clin. North Am. 20: 797, McComb, H. Primary repair of the bilateral cleft lip nose: A 4-year review. Plast. Reconstr. Surg. 94: 37, Reichert, H., and Gubisch, W. Various techniques of secondary nose correction in unilateral cleft-lip procedure. Ann. Plast. Surg. 26: 18, 1991.

Correction of Secondary Deformities of the Cleft Lip Nose

Correction of Secondary Deformities of the Cleft Lip Nose CME Correction of Secondary Deformities of the Cleft Lip Nose Samuel Stal, M.D., and Larry Hollier, M.D. Learning Objectives: After studying this article, the practitioner should be able to: 1. Describe

More information

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the lar Rim Richard Ellenbogen, MD; and Greg azell, MD ackground: lthough the alar rim has frequently been neglected in correction

More information

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Rotation-Advancement Principle in Cleft Lip Closure D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Correction of prealveolar, alveolar, and postalveolar clefts poses a fivefold project: natural appearance,

More information

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Primary Repair of Unilateral Cleft Lip Nasal Deformity CLEFT THE IRAQI LIP POSTGRADUATE NASAL DEFORMITY MEDICAL JOURNAL VOL.8, NO.3, 2009 Primary Repair of Unilateral Cleft Lip Nasal Deformity Zakaria Y.Arajy*, Ahmed A.M.Nawres** ABSTRACT: BACKGROUND: There

More information

UCL Repair: Emphasis on Muscle Dissection and Reconstruction

UCL Repair: Emphasis on Muscle Dissection and Reconstruction UCL Repair: Emphasis on Muscle Dissection and Reconstruction Unilateral cleft lip repair is performed using rotation-advancement technique. Markings are made on columella base, redlines, Cupid s bow on

More information

Nasal Soft-Tissue Triangle Deformities

Nasal Soft-Tissue Triangle Deformities 339 Hossam M.T. Foda, MD 1 1 Division of Facial Plastic Surgery, Otolaryngology Department, Alexandria Medical School, Alexandria, Egypt Facial Plast Surg 2016;32:339 344. Address for correspondence Hossam

More information

Advances of Plastic & Reconstructive Surgery

Advances of Plastic & Reconstructive Surgery Chapter 1 Advances of Plastic & Reconstructive Surgery Cleft lip nasal deformity: Analysis and treatment Martínez-Capoccioni Gabriel*; Martín-Martín Carlos Servizo Galego de Saúde, Service of ENT Head

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our

More information

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Fernando D. Burstein MD, FACS, FAAP Atlanta, Georgia, USA Rather than treating nasal, maxillary, and soft tissue

More information

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE ORIGINAL ARTICLE Erdem Tezel, MD, and Ayhan Numanoğlu, MD Abstract: Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of

More information

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report 220 Nasal septal reconstruction Case Report Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report Yakup Cil1* Diyarbakır Military Hospital, Department of Plastic Surgery 21000 Diyarbakır, Turkey

More information

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Original Article Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Yoon Seok Lee 1, Dong Hyeok Shin 1, Hyun Gon Choi 1, Jee Nam Kim 1, Myung Chul

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY THE NASAL SEPTUM IN RHINOPLASTY: BASIC SEPTOPLASTY TECHNIQUES FWA Otten Introduction Septal corrections form an important step in rhinoplastic

More information

Achieving a consistent functional and aesthetic

Achieving a consistent functional and aesthetic Special Topic Simplifying the Management of Caudal Septal Deviation in Rhinoplasty Fadi C. Constantine, M.D. Jamil Ahmad, M.D. Palmyra Geissler, M.D. Rod J. Rohrich, M.D. Dallas, Texas; and Mississauga,

More information

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages The Correction of a Secondary ilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

More information

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty.

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty. COSMETIC Classifying Deformities of the Columella Base in Rhinoplasty Michael R. Lee, M.D. Georges Tabbal, M.D. T. Jonathan Kurkjian, M.D. Jason Roostaeian, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background:

More information

The overprojected ( Pinocchio ) tip and the ptotic

The overprojected ( Pinocchio ) tip and the ptotic Featured Operative Technique Management of the Overprojected Nose and Ptotic Nasal Tip William E. Silver, MD, FCS; and Giancarlo F. Zuliani, MD The overprojected ( Pinocchio ) tip and the ptotic tip are

More information

Revision of the Cleft Lip Nose

Revision of the Cleft Lip Nose Revision of the Cleft Lip Nose Tom D. Wang, MD, FACS* Professor and Chief of Facial Plastic & Reconstructive Surgery Department of Otolaryngology / Head & Neck Surgery Oregon Health & Science University

More information

Surgical Management of Nasal Airway Obstruction

Surgical Management of Nasal Airway Obstruction Surgical Management of Nasal Airway Obstruction John F. Teichgraeber, MD a, Ronald P. Gruber, MD b, Neil Tanna, MD, MBA c, * KEYWORDS Nasal obstruction Nasal breathing Septal deviation Nasal valve narrowing

More information

Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board

Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board THE NASAL TIP IN BILATERAL HARE LIP By J. POTTER, F.R.C.S.Ed. Plastic Surgeon, Middlesbrough General Hospital, Stockton Children's Hospital, Newcastle Regional Hospital Board IN the problem of the bilateral

More information

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation Med. J. Cairo Univ., Vol. 83, No. 1, September: 585-589, 2015 www.medicaljournalofcairouniversity.net The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

More information

Cairo Dental Journal (24) Number (I), 77:84 January, Haitham Sayed Attia 3, Mohamed Saied Hamed 1 and Monteser El Koutobey 2

Cairo Dental Journal (24) Number (I), 77:84 January, Haitham Sayed Attia 3, Mohamed Saied Hamed 1 and Monteser El Koutobey 2 Cairo Dental Journal (24) Number (I), 77:84 January, 2008 Anthropometric Analysis of cases of Unilateral Cleft Lip Versus cases of Complete Unilateral Cleft Lip and Palate Haitham Sayed Attia 3, Mohamed

More information

Correction of the Retracted Alar Base

Correction of the Retracted Alar Base 218 William D. Losquadro, M.D. 1 Anthony Bared, M.D. 2 Dean M. Toriumi, M.D. 2 1 Mount Kisco Medical Group, Katonah, New York 2 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology

More information

The Crooked Nose and its Functional Surgical Correction

The Crooked Nose and its Functional Surgical Correction The Crooked Nose and its Functional Surgical Correction Armando González Romero Introduction The nose is a highly specialized organ of the respiratory system and is essential for homeostasis. The pathological

More information

CLINICAL NOTE. Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method

CLINICAL NOTE. Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method CLINICAL NOTE Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken s Method Seok-Kwun Kim, MD, PhD, Myung-Hoon Kim, MD, Yong-Seok Kwon, MD, and Keun-Cheol Lee, MD, PhD Purpose: To evaluate long-term

More information

Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients *

Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients * Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 27e33 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients * N. Chaithanyaa a, *, K.K. Rai b, H.R. Shivakumar

More information

Secondary rhinoplasty

Secondary rhinoplasty Free full text on www.ijps.org Secondary rhinoplasty Gaith Shubailat American Board of Plastic Surgery Address for correspondence: Gaith Shubailat, P. O. Box 5180, Amman, Jordan 11183. E-mail: gaith@shubailat.com

More information

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty IJMS Vol 36, No 3, September 2011 Original Article The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty Behrooz Gandomi 1, Mohammad Hossein Arzaghi

More information

There is no uniform grading system for nasal dorsal deformities currently in general use

There is no uniform grading system for nasal dorsal deformities currently in general use ORIGINAL ARTICLE A Grading System for Nasal Dorsal Deformities Matthew A. Kienstra, MD; Holger G. Gassner, MD; David A. Sherris, MD; Eugene B. Kern, MD There is no uniform grading system for nasal dorsal

More information

Surgical Treatment of Short Nose

Surgical Treatment of Short Nose Surgical Treatment of Short Nose Dr. Otto YT Au MD (JEFFERSON, USA) 1957, MCPS (MANITOBA) 1963, FHKAM (SURGERY) 1995 Diplomate American Board Plastic Surgery Plastic Surgery Specialist Dr.OttoYTAu A nice

More information

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection COSMETIC A Multivariate Analysis of Nasal Tip Deprojection Jacob G. Unger, M.D. Michael R. Lee, M.D. Robert K. Kwon, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background: Projection of the nasal tip is a

More information

19, 2006 RESIDENT PHYSICIAN:

19, 2006 RESIDENT PHYSICIAN: TITLE: Rhinoplasty SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: April 19, 2006 RESIDENT PHYSICIAN: Alan L. Cowan, M.D. FACULTY ADVISOR: David C. Teller, M.D. SERIES EDITORS: Francis

More information

Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series

Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series DOI: 10.7860/IJARS/2017/28759:2331 Surgery Section Case Series Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series JACOB JOHN, ARJUN MADHU USHA, MUBARAK AZIZ, VINIT RENKAN

More information

Rhinoplasty - Tip Augmentation by Extended Columellar Strip

Rhinoplasty - Tip Augmentation by Extended Columellar Strip World Articles of Ear, Nose and Throat ---------------------Page 1 Rhinoplasty - Tip Augmentation by Extended Columellar Strip Authors: Vikas Sinha*, Viral A. Chhaya**, Dilavar A. Barot***, Keyur Mehta****,

More information

Nose Reshaping (Rhinoplasty)

Nose Reshaping (Rhinoplasty) Nose Reshaping (Rhinoplasty) Are you interested in improving the appearance of your nose? If so, you re not alone. Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed

More information

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear The British Association of Plastic Surgeons (2004) 57, 238 244 Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear Yong Oock Kim*, Beyoung Yun Park, Won Jae Lee Institute

More information

Component Rhinoplasty

Component Rhinoplasty 18 Original Article Component Rhinoplasty Muhammad Humayun Mohmand*, Muhammad Ahmad Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan ABSTRACT BACKGROUND According

More information

The Prevention of Maxillary Collapse in

The Prevention of Maxillary Collapse in The Prevention of Maxillary Collapse in Congenital Lip and Palate Cases CHARLES E. HUGH H. JEROME E. HORTON, M.D. CRAWFORD, M.D. ADAMSON, M.D. SAMUEL BUXTON, D.D.S. REUBEN COOPER, M.S. JACK KANTER, D.D.S.

More information

Nasal Valve Obstruction

Nasal Valve Obstruction Nasal Valve Obstruction J RANDALL JORDAN, MD, FACS Facial Plastic Surgery Department of Otolaryngology and Communicative Disorders University of Mississippi Medical School Disclosures Financial- none Off-label-none

More information

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide 537643AESXXX10.1177/1090820X14537643Aesthetic Surgery JournalÇakır et al research-article2014 INTERNATIONAL CONTRIBUTION Featured Operative Technique Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step

More information

Use of tent-pole graft for setting columella-lip angle in rhinoplasty

Use of tent-pole graft for setting columella-lip angle in rhinoplasty Agrawal et al. Plast Aesthet Res 2018;5:13 DOI: 10.20517/2347-9264.2018.17 Plastic and Aesthetic Research Letter to Editor Open Access Use of tent-pole graft for setting columella-lip angle in rhinoplasty

More information

Compared with other ethnicities, Asians have

Compared with other ethnicities, Asians have Original Article Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting Jin Suk Byun, MD, PhD* Kenneth K. Kim, MD, FACS, Background: Asians with short nose

More information

45 SECONDARY LZ CORRECTION

45 SECONDARY LZ CORRECTION 45 SECONDARY LZ CORRECTION AFTER ROTATION AND ADVANCEMENT NOT ENOUGH ROTATION MOST COMMON COMPLAINT BY SURGEONS USING THE ROTATIONADVANCEMENT METHOD HAS BEEN SHORTNESS OF THE VERTICAL HEIGHT OF THE LIP

More information

Bony hump reduction is an integral part of classic

Bony hump reduction is an integral part of classic Rhinoplasty Nasal Hump Reduction With Powered Micro Saw Osteotomy INTERNATIONAL CONTRIBUTION Yakup Avşar, MD Background: Hump reduction with manual osteotomy is an invasive procedure in aesthetic rhinoplasty.

More information

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery DOI 10.1007/s00266-010-9562-2 ORIGINAL ARTICLE The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery Hani Abou Mayaleh Received: 11 April 2010 / Accepted: 15 July 2010 Ó Springer Science+Business

More information

Hospital das Clinicas, Brazil

Hospital das Clinicas, Brazil THE IMPORTANCE OF THE CARTILAGINOUS FRAMEWORK IN PLASTIC SURGERY OF THE NOSE By ROBERTO FARINA, M.D., OSVALDO DE CASTRO, and RICARDO BAROUDI, M.D. Hospital das Clinicas, Brazil As far as plastic surgery

More information

Unilateral cleft nasal deformity is a clinical term referring to a nose

Unilateral cleft nasal deformity is a clinical term referring to a nose ORIGINAL ARTICLE Assessment of Secondary Cleft Rhinoplasty Using Resorbable Plates at the Age of Primary School Arun K. Gosain, MD and Amir H. Fathi, MD Background: Secondary rhinoplasty after a cleft

More information

BONE GRAFTING IN TREATMENT OF CLEFT LIP AND PALATE 337

BONE GRAFTING IN TREATMENT OF CLEFT LIP AND PALATE 337 PRIMARY BONE GRAFTING IN THE TREATMENT OF CLEFT LIP AND PALATE WITH SPECIAL REFERENCE TO ALVEOLAR COLLAPSE By FRANK ROBINSON, F.R.C.S., and BARRIE WOOD, L.D.S. Burns and Plastic Surgery Unit, Booth Hall

More information

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas.

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas. Operative Techniques in Otolaryngology (2007) 18, 233-242 Closed rhinoplasty Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD From the Center for Aesthetic Surgery, Colleyville, Texas. KEYWORDS

More information

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications:

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications: MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.038.MH Septoplasty-Rhinoplasty This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst

More information

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Ahmed Elshahat, MD Plastic Surgery Department, Faculty of Medicine, Ain Shams University; and Eldemerdash Hospital, Cairo, Egypt

More information

ORIGINAL ARTICLE. Surgery for the Dysfunctional Nasal Valve

ORIGINAL ARTICLE. Surgery for the Dysfunctional Nasal Valve Surgery for the Dysfunctional Nasal Valve Cadaveric Analysis and Clinical Outcomes Rodney J. Schlosser, MD; Stephen S. Park, MD ORIGINAL ARTICLE Objectives: To quantify changes in the cross-sectional area

More information

Upper Triangular Flap Method for Primary Repairs of Incomplete Unilateral Cleft Lip Patients. Minor to Two-Thirds Way Defects

Upper Triangular Flap Method for Primary Repairs of Incomplete Unilateral Cleft Lip Patients. Minor to Two-Thirds Way Defects HEAD AND NECK SURGERY Upper Triangular Flap Method for Primary Repairs of Incomplete Unilateral Cleft Lip Patients Minor to Two-Thirds Way Defects Kyung S. Koh, MD, PhD,* Tae Suk Oh, MD,* and Jin Woo Song,

More information

Figure 1. Basic anatomy of the palate

Figure 1. Basic anatomy of the palate CHAPTER 10 CLEFT LIP AND PALATE Chen Yan, MD and Sanjay Naran, MD I. ANATOMY AND DEFINITIONS A. Cleft Lip (CL) alone, Cleft Lip with Cleft Palate (CLP), and Cleft Palate (CP) alone 1. CL alone and CLP

More information

Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery

Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery By GRAEME M. CLARK (Melbourne) IN nasal surgery, cartilage or bone transplants are required for support or correction of

More information

24 EARLY ACCEPTANCE IN

24 EARLY ACCEPTANCE IN IN COMPLETE CLEFTS 24 EARLY ACCEPTANCE IN IN COMPLETE CLEFTS OFTEN IT HAS BEEN SAID EEAN INCOMPLETE CLEFT CAN BE MORE DIFFICULT THAN COMPLETE ONE YET WITH LESS TISSUE MISSING LESS NASAL DISTORTION AND

More information

Vancouver, B.C., Canada

Vancouver, B.C., Canada THE "ALAR SHIFT" REVISITED By THEODORE F. WILKIE, B.A., M.D., F.R.C.S.(C), F.A.C.S. Vancouver, B.C., Canada IN the hands of many plastic surgeons certain procedures have an evanescent history. Usually

More information

ORIGINAL ARTICLE. patients with impaired nasalbreathingandaestheticdiscomfortduetostenosisofthenasalvestibule.

ORIGINAL ARTICLE. patients with impaired nasalbreathingandaestheticdiscomfortduetostenosisofthenasalvestibule. ORIGINAL ARTICLE Postoperative Management of Nasal Vestibular Stenosis The Custom-made Vestibular Device Dirk-Jan Menger, MD; Peter J. F. M. Lohuis, MD, PhD; Steven Kerssemakers, MD; Gilbert J. Nolst Trenité,

More information

Surgical Treatment of Nasal Obstruction

Surgical Treatment of Nasal Obstruction Surgical Treatment of Nasal Obstruction P. Daniel Knott, MD FACS Director, Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology/Head and Neck Surgery UCSF Medical Center Nothing

More information

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty British Journal of Plastic Surgery (2003), 56, 218 223 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00117-6 The

More information

SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015

SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015 SEMI- ANNUAL FELLOWSHIP REPORT June 2015 to December 2015 Submitted by, Dr.Arun Ramaiah., Resident fellow, St.Thomas Cleft and Craniofacial centre. Letter to CCI To start with I would like to thank Cleft

More information

New York Science Journal 2017;10(5) Primary Rhino-cheiloplasty in unilateral Cleft lip.

New York Science Journal 2017;10(5)  Primary Rhino-cheiloplasty in unilateral Cleft lip. Primary Rhino-cheiloplasty in unilateral Cleft lip Abd Elmoneim H. Hota 1, Magdy A. Abdelmoktader 1, Refaat I. El Badawy 2 and Ahmed F. Salem 1 1 Plastic Surgery Department Faculty of Medicine, Alazhar

More information

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Research Original Investigation Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Yan Ho, MD; Robert Deeb, MD; Richard Westreich, MD; William Lawson, MD, DDS IMPORTANCE Resection of

More information

The correction of nasal septal deviations in rhinoplasty

The correction of nasal septal deviations in rhinoplasty Page 1 of 9 Aesthetic Surgery & Medicine The correction of nasal septal s in rhinoplasty P Persichetti 1 *, V Toto 1, M Signoretti 1, R Del Buono 1, B Brunetti 1, F Segreto 1, D Lazzeri 2, GF Marangi 1

More information

Thomas T. Jeneby, M.D Wurzbach Suite 801 San Antonio, TX /

Thomas T. Jeneby, M.D Wurzbach Suite 801 San Antonio, TX / Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed today. Often, the structure or size of the nose is not proportionate with the other features on the face.

More information

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods Plastic Surgery International Volume 0, Article ID 4578, 4 pages doi:0.55/0/4578 Clinical Study Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with

More information

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC Anatomy of External NOSE By Dr Farooq Aman Ullah Khan PMC 24 th Nov. 2017 The External Nose Descriptions of the nose always begin with that part of it which is covered by the skin, i.e., the EXPOSED PART

More information

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities

Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities Free full text on www.ijps.org Review Article DOI: 10.4103/0970-0358.57195 Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities Mimis Cohen, David E. Morris, Aisha D.

More information

Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study

Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study Effect of Preoperative Nasal Retainer on Nasal Growth in Patients with Bilateral Incomplete Cleft Lip: A 3-Year Follow-Up Study Original Article Young Chul Kim, Woo Shik Jeong, Tae Suk Oh, Jong Woo Choi,

More information

Nasal Anatomy and Analysis

Nasal Anatomy and Analysis INVITED REVIEW ARTICLE Guy Kenyon ABSTRACT This article describes the anatomy of the nose and the principles of analysis of the nose and face that will aid a successful rhinoplasty. The analysis is based

More information

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective Plastic Surgery International, Article ID 202560, 7 pages http://dx.doi.org/10.1155/2014/202560 Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective William

More information

Rhinoplasty: Personal Evolution and Milestones

Rhinoplasty: Personal Evolution and Milestones Cosmetic Rhinoplasty: Personal Evolution and Milestones Jack H. Sheen, M.D. Santa Barbara, Calif. Over the past 35 years, aesthetic rhinoplasty has evolved from a generic, reductive operation to a highly

More information

The anatomical basis for a cleft lip defect is far

The anatomical basis for a cleft lip defect is far PEDIATRIC/CRANIOFACIAL Comparison of Three Incisions to Repair Complete Unilateral Cleft Lip Srinivas Gosla Reddy, M.D.S., M.B.B.S. Rajgopal R. Reddy, B.D.S., M.B.B.S. Ewald M. Bronkhorst, Ph.D. Rajendra

More information

Reconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal Battens or by Septal Replacement: An Overview and Comparison of Techniques

Reconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal Battens or by Septal Replacement: An Overview and Comparison of Techniques The Laryngoscope Lippincott Williams & Wilkins, Inc. 2006 The American Laryngological, Rhinological and Otological Society, Inc. Reconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal

More information

Spreader Graft in Closed Rhinoplasty: The Rail Spreader

Spreader Graft in Closed Rhinoplasty: The Rail Spreader Original Article 515 Spreader Graft in Closed Rhinoplasty: The Rail Spreader Alberto Scattolin, MD 1 Niana Orlando, MD 1 Luca D Ascanio, MD 2 1 Department of Otolaryngology, Villa Donatello Clinic, Piazzale

More information

ONE out of every eight hundred children in the United States is born with

ONE out of every eight hundred children in the United States is born with REPAIR OF THE CLEFT LIP ROBIN ANDERSON, M.D. Department of Plastic Surgery ONE out of every eight hundred children in the United States is born with a cleft lip, a cleft palate, or both. Within this group

More information

The Role of the Lip Adhesion Procedure. in Cleft Lip Repair*

The Role of the Lip Adhesion Procedure. in Cleft Lip Repair* The Role of the Lip Adhesion Procedure in Cleft Lip Repair* RALPH HAMILTON, M.D. WILLIAM P. GRAHAM, III, M.D. PETER RANDALL, M.D. Philadelphia, Pa. 19104 Introduction A lip adhesion procedure utilizing

More information

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1 Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) -, -e- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

More information

RHINOPLASTY (NOSE RE-SHAPING)

RHINOPLASTY (NOSE RE-SHAPING) PROCEDURE FACT SHEET PLASTIC SURGERY RHINOPLASTY (NOSE RE-SHAPING) This is a guide for people who are considering having a nose re-shaping (Rhinoplasty) operation. We advise that you talk to a plastic

More information

Cleft Lip and Palate: The Effects on Speech and Resonance

Cleft Lip and Palate: The Effects on Speech and Resonance Ann W. Kummer, PhD, CCC-SLP Cincinnati Children s Cleft lip and/or palate can have a negative impact on both speech and resonance. The following is a summary of normal anatomy, the types and causes of

More information

Construction of the congenitally missing columella in midline clefts

Construction of the congenitally missing columella in midline clefts Construction of the congenitally missing columella in midline clefts Kurt-Wilhelm BÜTOW Department of Maxillo-Facial and Oral Surgery (Head: Prof. Kurt-W. Bütow, MChD(OMFSurg), DMD, PhD, DSc(Odont), FCMFOS),

More information

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D.

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Techniques in Cosmetic Surgery Rhinoplasty with Advancing Age Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Houston and Dallas, Texas Rhinoplasty in the

More information

New Instruments for Submembranous Dissection in Rhinoplasty

New Instruments for Submembranous Dissection in Rhinoplasty Letter to the Editor New Instruments for Submembranous Dissection in Rhinoplasty Aesthetic Surgery Journal 2017, Vol 37(7) NP73 NP78 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints

More information

Modified Endonasal Tongue-in-Groove Technique

Modified Endonasal Tongue-in-Groove Technique Rapid Communication 569 Sameep Kadakia, MD 1 Alexander Ovchinsky, MD 1 1 Department of Otolaryngology - Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York Facial Plast

More information

Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty

Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty Park and Kim Maxillofacial Plastic and Reconstructive Surgery (2018) 40:43 https://doi.org/10.1186/s40902-018-0182-0 Maxillofacial Plastic and Reconstructive Surgery RESEARCH Bilateral cleft lip repair

More information

Combining Rhinoplasty with Septal Perforation Repair

Combining Rhinoplasty with Septal Perforation Repair Combining Rhinoplasty with Septal Perforation Repair Hossam M.T. Foda, M.D. 1 and Emad A. Magdy, M.D. 1 ABSTRACT A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting

More information

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP By MICHAL KRAUSS Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION of the nose is one of the composite procedures in

More information

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse Aesth Plast Surg (2009) 33:625 634 DOI 10.1007/s00266-009-9349-5 ORIGINAL ARTICLE Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse Valerio Cervelli Æ Diana Spallone

More information

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty Niveditha J Sagar, Chidananda R Devasamudra Original article 10.5005/jp-journals-10013-1254 Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty 1 Niveditha J Sagar, 2 Chidananda

More information

By SIDNEY KAHN, M.D., and JOSEPH WINSTEN, M.D. From the Plastic Surgical Service of Dr Arthur 3?. Barsky, Mount Sinai Hospital, New York City

By SIDNEY KAHN, M.D., and JOSEPH WINSTEN, M.D. From the Plastic Surgical Service of Dr Arthur 3?. Barsky, Mount Sinai Hospital, New York City SURGICAL APPROACHES TO THE BILATERAL CLEFT LIP PROBLEM By SIDNEY KAHN, M.D., and JOSEPH WINSTEN, M.D. From the Plastic Surgical Service of Dr Arthur 3?. Barsky, Mount Sinai Hospital, New York City INTRODUCTION

More information

Remember from the first year embryology Trilaminar disc has 3 layers: ectoderm, mesoderm, and endoderm

Remember from the first year embryology Trilaminar disc has 3 layers: ectoderm, mesoderm, and endoderm Development of face Remember from the first year embryology Trilaminar disc has 3 layers: ectoderm, mesoderm, and endoderm The ectoderm forms the neural groove, then tube The neural tube lies in the mesoderm

More information

27 DETAILS OF CONVERTING ASYMMETRICAL

27 DETAILS OF CONVERTING ASYMMETRICAL 27 DETAILS OF CONVERTING ASYMMETRICAL CLEFTS INTO COMPLETE BILATERAL CLEFTS AND BANKING THE FORK ONE SIDE OF BILATERAL CLEFT IS INCOMPLETE THE SITUA DON REDUCES THE AMOUNT OF DISCREPANCY AND DISTORTION

More information

Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip

Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip Unilateral Cleft Lip Repair by using White-skin-roll Flap from Cleft Side of Lip Background: With all due consideration to the restoration of function, post-operative aesthetic appearance of the cleft

More information

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique Archives of Craniofacial Surgery Arch Craniofac Surg Vol.19 No.1, 3-12 https://doi.org/10.7181/acfs.2018.19.1.3 Personal technique for definite repair of complete unilateral cleft lip: modified Millard

More information

Residual deformities after repair of clefts of the lip and palate

Residual deformities after repair of clefts of the lip and palate Clin Plastic Surg 31 (2004) 331 345 Residual deformities after repair of clefts of the lip and palate Mimis Cohen, MD, FACS, FAAP a,b, * a Divisions of Plastic, Reconstructive, and Cosmetic Surgery, The

More information

A new classification system of nasal contractures

A new classification system of nasal contractures Original Article J Cosmet Med 2017;1(2):106-111 https://doi.org/10.25056/jcm.2017.1.2.106 pissn 2508-8831, eissn 2586-0585 A new classification system of nasal contractures Geunuck Chang 1, Donghak Jung

More information

CHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2)

CHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2) CHAPTER 17 FACIAL AESTHETIC SURGERY Christopher C. Surek, DO and Mohammed S. Alghoul, MD I. BROW LIFT (Figures 1 and 2) A. Open Coronal Brow Lift Technique 1. Coronal incision is made in the hair-bearing

More information

Despite a multiplicity of surgical approaches to PEDIATRIC/CRANIOFACIAL. Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate

Despite a multiplicity of surgical approaches to PEDIATRIC/CRANIOFACIAL. Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate PEDIATRIC/CRANIOFACIAL Primary Septoplasty in the Repair of Unilateral Complete Cleft Lip and Palate Srinivas Gosla-Reddy, M.B.B.S., M.D.S. Krisztian Nagy, M.D., D.D.S. Maurice Y. Mommaerts, M.D., D.M.D.,

More information

MEDPOR. Plastic surgery

MEDPOR. Plastic surgery MEDPOR Plastic surgery MEDPOR biomaterial MEDPOR has been a trusted name in the industry since 1985, with hundreds of thousands of procedures performed, and hundreds of published clinical reports in reconstructive,

More information