A Correction of Hypoplastic Alar Nasi in Cleft Lip Nose Deformity : Using A Subcutaneous Reduction of Ala and External Lateral Triangle of the Non-Cleft Side

Han, Ki Hwan; Lim, Joong Jae; Kim, Jun Hyung

Abstract

One of the problems in the correction of the cleft lip nose deformity is the hypoplastic alar nasi on the affected side, even after secondary rhinoplasty. This deformity was managed with various cartilage grafts for augmentation of the cleft side, but that procedures have been complicated by inadequate cartilage augmentation, complex procedure, unpredictable results. To overcome the problem of the hypoplastic alar nasi, the authors used subcutaneous reduction of the upper part of the ala and external lateral triangle on the non-cleft side through the intranasal approach. Additional techniques including partial-thickness incisions of the septal cartilage, freeing of the septal cartilage from the vomer, the nasal osteotomy, a z-plasty on the affected plica vestibularis and cinching of denuded alar base of the affected side or an interalar cinch were also used to repair individual differences of the nasal deformities. The authors performed 20 cases (11 women and 9 men) of the correction of the unilateral cleft lip nose deformity between 1997 and 1999. The patient, ranged in age from 19 years to 51 years at the time of surgery, with a mean age of 24 years. Eight to twenty (mean twelve) months postoperatively, the patients were evaluated by the ordinary scale method and the photogrammetric measurements using preoperative and postoperative photos. All the patients showed uneventful healing except two cases of superficial skin necrosis. By the ordinary scale method, "good" aesthetic results were noted. By the photogrammetric measurement, the alar height of non-cleft were significantly decreased. The results showed a relatively symmetrical alar height index of both cleft and non-cleft sides. In conclusion, the procedure is very simple and fast to perform, and it is easy to achive nasal symmetry. It is possible to use the procedure with additional techniques in the various deformities for the better results.