Correction of Cleft Lip Nasal Deformity using Refined Reverse-U Incision and V-Y Plasty

Lee, Jong Hyup; Park, Jae Woo; Cho, Byung Chae; Baik, Bong Soo

Abstract

Forty-five patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. Thirty-five were followed up. Among them, 31 patients had unilateral cleft lip nasal deformities and 4 had bilateral cleft lip nasal deformities. The age range of the patients was from 3 to 56 years old. Reverse-U incision and V-Y plasty were used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. Bilateral reverse-U incisions and transcolumella incisions were used in 4 patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were performed to make firm contact between the nasal skin and the redraped reverse- U flap. Ancillary procedures included correction of the laterally displaced alar base, lip scar revision, cartilage graft for tip augmentation, iliac bone graft for correcting hypoplasia of the maxilla or an alveolar cleft, corrective rhinoplasty, and composite graft for columella lengthening. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 to 26 months, with an average of 18 months. Final results were evaluated based on the degree of symmetry of both nostrils, conditions of the redraped alar-columella web, and exposure of the nostril. Good results were obtained in 29 patients where alar-columella web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was acquired. Four patients showed fair results, and 2 poor. In conclusion, these results suggest that the reverse-U incision and V-Y plasty are useful methods for creating a symmetry of the nostrils in cases of cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.