Correction of Retracted Ala Using Spacer Graft in Secondary Cleft Lip and Nose Deformity.

Han, Kyu Seok; Choi, Hyun Gon; Shin, Dong Hyeok; Kim, Soon Heum; Hwang, Eun A; Uhm, Ki Il

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2011;38(4):376-382.
Published online July 1, 2011.

Correction of Retracted Ala Using Spacer Graft in Secondary Cleft Lip and Nose Deformity.

Kyu Seok Han, Hyun Gon Choi, Dong Hyeok Shin, Soon Heum Kim, Eun A Hwang, Ki Il Uhm

Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea. kiumps@hanmail.net

Abstract

PURPOSE
In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. METHODS: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo.
RESULTS
Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty.
CONCLUSION
The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.

Keywords: Secondary cleft lip and nose deformity; Alar retraction; Spacer graft; Septal extension graft