Wraparound Cartilage Flap for Correction of Cleft-Lip Nasal Deformity

EDITORIAL COMMENT

This is another technique that attempts to obtain symmetry of the normal alar cartilage with a slanted one from a cleft-lip deformity. A satisfactory and similar result can be obtained with the free use of a cartilage graft as an onlay procedure.

A turnover contralateral lower lateral alar cartilage flap is suggested for the correction of cleft nose alar deformity. The flap wraps around the deficient medial crus and acts as a pulley, repositioning and augmenting the affected alar cartilage.

INDICATIONS

Cleft-lip nasal deformity includes lateral displacement of the medial crus, as well as depressed and laterally deflected lower lateral alar cartilage. In addition, there is a relatively larger, retrodisplaced naris, with deviation of the nasal tip to the noncleft side. Definitive correction of cleft-lip nasal deformity is difficult to achieve, and there is no ideal surgical procedure for all deformities (1, 2, 3, 4). The technique presented repositions the affected lower lateral cartilage and augments and suspends the medial crus to make the nasal tip as symmetrical as possible.

OPERATIVE TECHNIQUE

Under local or general anesthesia with local infiltration, an open nasal approach is carried out with a V-shaped columellar incision. This enables direct visualization and appreciation of the degree of deformity. In cases of a short columella, the V-to-Y closure of the incision offers a 2 to 3 mm increase in columellar length. After the incision has been completed and the medial crura identified, the cartilage is exposed with bilateral rim incisions. Horizontal markings determine the proposed height of the alar cartilage (Fig. 46.1A).

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