An Ultimate Method for Cleft Nasal Deformity Correction at Primary Lip Surgery: Innovative Concepts and Review
Archives of Oral and Maxillofacial Surgery
Unilateral cleft lip nasal deformity (UCLND) has been investigated and written about far more than the Bilateral counterpart, an observation that can be easily made upon reviewing this subject     . The rationale is not barely, the solutions applied to the former can simply be applied on both sides. It is the tilt of the tripod in the Unilateral cases beginning with the infrastructure (maxilla) up to the skin and hence the asymmetry, what challenged surgeons the most . Surgical
... ost . Surgical Techniques Abstract The Nasal deformity in individuals with clefts has been an area of controversies, challenges and diversity of techniques. The aesthetic outcomes have barely been acceptable or below expectations most of the time and globally. Method: We believe on the theory of a "collapsing pyramid" for the Nasal cartilaginous framework in clefts. Hence, we came up with a true suspension technique. The entire cartilaginous structure is lifted from infra tip region, with a loop suture and being secured onto the periosteum overlying nasal bone in a cantilever fashion. This method is being used at the primary stage in both Unilateral and Bilateral Nasal-cleft lip deformities. Major works and milestones relevant to this topic by renowned authors are reviewed and discussed. Results: The technique was first applied over 10-years-ago. Nine children whose parents consented to the developing technique have been presented, with follow ups ranging from few months to years. Technical descriptions and illustrative drawings made by the author are portrayed. None of the cases has had preoperative orthopedic procedures, moldings or even postoperative nostril splints. The aesthetic outcome was adequately striking and optimum, none of the cases requested a secondary correction to the nose. Conclusion: The new nasal suspension technique is an innovative concept, which can be used in conjunction to an appropriate lip repair method as per the surgeon's preference. The main drawback would be the need for a learning curve. Overall, we believe this is an ultimate solution for the severe nasal deformity, since it truly suspends the nose in a cantilever fashion, securing it to a stable structure, the periosteum of the nasion.