Photogrammetric Analysis of the Correction of Nasal Deformity in Bilateral Cleft Lip using Bardach's Techique

Kim, Suk Wha; Park, Young Oh

Abstract

The secondary nasal deformity in bilateral cleft lip has distinct characteristics such as the absence of septal deviation, short columella, both alar flaring, web of the alar rim, wide nostrils, dislocation and separation of the alar cartilage with an obtuse angle. Bardach's technique was applied for both a nasal tip projection and lengthening the columella in the secondary nasal deformity. In this procedure, the columella was lengthened using a skin flap from the prolabium, and the lateral crura of the lower lateral cartilages were dissected from the skin and nasal mucosa. The lower lateral cartilage was also restructured by lengthening the medial crura and shortening the lateral crura by suturing them together at the appropriate height to establish the proper cartilage support for a projected and symmetric nasal tip and to reconstruct the columella. A V-Y closure of the defect on the lip was done to lengthen the midsection of the lip. A photogrammetric comparison of the pre-operation and post-operation was made(n=10 ; M : F=7 : 3). The facial proportions and angles were measured by photography using defined anthropometric points. The following criteria were quantified for the preoperative states and postoperative states: the nasolabial angle, nasal tip angle and projection, nasal width, columellar length and width, and the philtral width. All parameters in both states were compared against each other. Results were analyzed by a non-parameter test. The nasolabial angle, nasal tip angle, nasal tip protrusion, columellar lengthening proved to be better after surgery(p<0.01). In conclusion, Bardach's technique is suitable method for correcting the secondary deformity associated with bilateral cleft lip by nasal tip projection, columella lengthening and preventing recurrence. However, It is not suitable for the reduction of alar width and the formation of philtral groove.