Let-Down Rhinoplasty in Patients With Cleft Lip Nose.
| Title: | Let-Down Rhinoplasty in Patients With Cleft Lip Nose. |
|---|---|
| Authors: | Tapan M; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University Faculty of Medicine, Antalya, Türkiye.; Şeker YE; Zöhre CT; İşler VC; Özpar EB; Özkan Ö; Özkan Ö |
| Source: | Annals of plastic surgery [Ann Plast Surg] 2023 Nov 01; Vol. 91 (5), pp. 564-570. Date of Electronic Publication: 2023 Aug 31. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Little, Brown And Company Country of Publication: United States NLM ID: 7805336 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1536-3708 (Electronic) Linking ISSN: 01487043 NLM ISO Abbreviation: Ann Plast Surg Subsets: MEDLINE; PubMed not MEDLINE |
| Imprint Name(s): | Publication: Boston Ma : Little, Brown And Company; Original Publication: Boston, Little, Brown. |
| Abstract: | Background and Objectives: Rhinoplasty in patients with cleft lip nose (CLN) deformity is challenging. Cleft lip nose deformity primarily affects the nasal tip, columella, nostrils, alar base, floor, and septum. The needs of patients with CLN are quite different from those of patients who undergo primary rhinoplasty. Recently, the dorsal preservation rhinoplasty technique has gained popularity. We applied this technique to patients with CLN deformity to obtain better aesthetic and functional results.; Patients and Methods: Ten consecutive patients with indication for primary CLN reconstruction underwent let-down rhinoplasty. Rhinoplasties were performed using either the closed or open approach, with costal cartilage grafts and full-thickness skin grafts. A rhinoplasty outcome evaluation questionnaire was used to assess the results. Moreover, the use of the same questionnaire in prior patients allowed us to compare results between our previous and new techniques.; Results: The study included 6 female and 4 male patients, with ages ranging from 18 to 25 years. Only 1 patient had a history of bilateral cleft lip. Seven patients had a history of left-sided cleft lip, and 2 patients had right-sided cleft lip. Open-approach let-down rhinoplasty with costal cartilage grafts and full-thickness skin grafts was performed in 8 patients, whereas closed-approach let-down rhinoplasty with costal cartilage grafts was performed in 2 patients. Columellar struts and affected-side onlay costal cartilage grafts were used in all patients. All patients reported being satisfied with the let-down rhinoplasty outcome, and none complained of functional problems. However, nostril symmetry was not observed in some patients, particularly in patients who underwent closed-approach rhinoplasty.; Conclusions: Combining open approach, full-thickness skin graft, costal cartilage graft, and let-down rhinoplasty shows promising and satisfactory outcomes in patients with CLN. However, further studies are required to confirm this observation.; (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
| Competing Interests: | Conflicts of interest and source of funding: none declared. |
| References: | Sykes JM, Jang YJ. Cleft lip rhinoplasty. Facial Plast Surg Clin North Am . 2009;17:133–144.; Nolst Trenité GJ, Paping RH, Trenning AH. Rhinoplasty in the cleft lip patient. Cleft Palate Craniofac J . 1997;34:63–68.; Daniel RK, Kosins AM. Current trends in preservation rhinoplasty. Aesthet Surg J Open Forum . 2020;2:ojaa003.; Saban Y, Daniel RK, Polselli R, et al. Dorsal preservation: the push down technique reassessed. Aesthet Surg J . 2018;38:117–131.; Izu SC, Kosugi EM, Brandão KV, et al. Normal values for the Rhinoplasty Outcome Evaluation (ROE) questionnaire. Braz J Otorhinolaryngol . 2012;78:76–79.; Montes-Bracchini JJ. Nasal profile hump reduction using the let-down technique. Facial Plast Surg . 2019;35:486–491.; Canfield MA, Honein MA, Yuskiv N, et al. National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol . 2006;76:747–756.; Cottle MH, Loring RM. Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Eye Ear Nose Throat Mon . 1947;26:207–212.; Drumheller GW. The cottle push down operation. Am J Cosmet Surg . 1995;12:255–261.; Huizing EH. Push-down of the external nasal pyramid by resection of wedges. Rhinology . 1975;13:185–190.; Finocchi V, Vellone V, Ramieri V, et al. Pisa tower concept: a new paradigm in crooked nose treatment. Plast Reconstr Surg . 2021;148:66–70.; Abdelwahab MA, Neves CA, Patel PN, et al. Impact of dorsal preservation rhinoplasty versus dorsal hump resection on the internal nasal valve: a quantitative radiological study. Aesthetic Plast Surg . 2020;44:879–887.; Wright WK. Principles of nasal septum reconstruction. Trans Am Acad Ophthalmol Otolaryngol . 1969;73:252–255.; Kosins AM. Preservation rhinoplasty: open or closed? Aesthet Surg J . 2022;42:990–1008.; Öreroğlu AR, Çakır B, Akan M. Lateral crural steal procedure in rhinoplasty: the maths behind. In: The Rhinoplasty Society 17th Annual Meeting; May 1–5, 2012; Vancouver, British Columbia, Canada.; Patrocínio LG, Patrocínio TG, Barreto DM, et al. Evaluation of lateral crural steal in nasal tip surgery. JAMA Facial Plast Surg . 2014;16:400–404.; Çakır B, Öreroğlu AR, Daniel RK. Surface aesthetics in tip rhinoplasty: a step-by-step guide. Aesthet Surg J . 2014;34:941–955.; Cerkes N. Nasal tip deficiency. Clin Plast Surg . 2016;43:135–150.; Foda HM, Kridel RW. Lateral crural steal and lateral crural overlay: an objective evaluation. Arch Otolaryngol Head Neck Surg . 1999;125:1365–1370.; Çakır B, Doğan T, Öreroğlu AR, et al. Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 2013;33:363–375.; Millard DR. Columellar lengthening by a forked flap. Plast Reconstr Surg . 1958;22:454.; Ozaki W, Chaffoo RA, Vu KC, et al. Comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using conchal composite grafts. J Craniomaxillofac Surg . 2006;34:150–155.; Champion R. Reconstruction of the columella. Br J Plast Surg . 1960;12:353–355.; Cronin TD, Upton J. Lenghthening of the short columella associated with bilateral cleft lip. Ann Plast Surg . 1978;1:75–95.; Abbe R. A new plastic operation for the relief of deformity due to double harelip. Last Reconstr Surg . 1968;42:481–483.; Lee YS, Shin DH, Choi HG, et al. Columella lengthening with a full-thickness skin graft for secondary bilateral cleft lip and nose repair. Arch Plast Surg . 2015;42:704–708.; Zhang Z, Huang TC, He Y, et al. Modified use of costal cartilage in asians for the correction of nostril asymmetry in unilateral secondary cleft lip nasal deformity. Ann Plast Surg . 2021;86:175–181. |
| Entry Date(s): | Date Created: 20230831 Latest Revision: 20250617 |
| Update Code: | 20260130 |
| DOI: | 10.1097/SAP.0000000000003681 |
| PMID: | 37651679 |
| Database: | MEDLINE |
Journal Article