Primary repair of bilateral complete cleft lip nasal deformity : Iraqi experience

الملخص EN

Background : simultaneous surgical correction of bilateral cleft lip nasal deformity is becoming more common.

This is a major change from the conventional strategy of secondary nasal correction.

Many studies had concluded that primary nasal repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.

Aim : this study was conducted to document the pattern of primary nasal repair in bilateral complete cleft lip deformity and to evaluate the medium term outcome.

Method : A total of 13 babies with bilateral complete nasolabial clefts underwent simultaneous nasal correction with their lip closure.

Mean age was 4 months.

The study was performed between March 2006 and April 2009.

Alar cartilage manipulation using combined Mulliken-Cutting retrograde nasal approach was performed for all cases.

Results : the average follow up periods were 3 years (ranging from 6 months–6 years).

The results were evaluated by comparing 3 nasal anthropometric measurements with those of normal, age-matched children pre and postoperatively at 3 months and then yearly till 3 years.

The selected nasal anthropometric measurements were : nasal tip projection, columellar length, and interalar distance.

Nasal tip projection and columellar length were normal or near normal in 5 babies but slightly shorter than in control group in 8 babies.

The interalar distance was near normal in 9 babies but moderately wider than in control group in 4 babies.

In one case, partial prolabial flap necrosis occurred and was revised successfully 6 months later.

In another 2 cases, a hypertrophic scar formed on the upper lip which subsided after 6 months of scar management.

Over all nasal tip shapes were improved in all cases with acceptable nostrils asymmetry.

Conclusions : in cases where presurgical molding is not available, a combined Mulliken-Cutting approach is advisable for obtaining a reasonable primary nasal repair in bilateral complete cleft lip deformity.

It is not advisable to create a philtral dimple with a deep dermal suture at the prolabial flap as it may compromise the blood supply.

Alar dome suspension stitches might be useful for further improvement of alar dome projection.

A long follow-up is needed to observe nasal growth over time and detail final outcomes.