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Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose.
Plast Reconstr Surg. 2005 Nov; 116(6):1613-9; discussion 1620-2.PR

Abstract

BACKGROUND

Since 1990, primary bilateral cleft nasal reconstruction has been focused on placing the lower lateral cartilages into normal anatomical position. Of the four major techniques in this class, the Cutting (i.e., retrograde) method and the Mulliken method have been most successful. The retrograde method makes no external nasal incisions, but requires either preoperative or postoperative nasal molding to achieve maximum benefit. Mulliken's technique does not require molding, but leaves the footplates of the medial crura in the depression above the projecting premaxilla associated with the diminutive anterior nasal spine. Leaving the footplates in place also prevents adequate approximation of the alar bases. In this article, the two methods are combined to achieve the benefits of both.

METHODS

We report our experience with the retrograde nasal approach associated with marginal rim incisions (Mulliken method) in a series of 25 consecutive bilateral cleft lip cases simultaneous with lip repair. We performed a retrograde approach through membranous septum incisions elevating a prolabial-columellar flap. To facilitate alar cartilage manipulation we added bilateral marginal rim incisions. Nasal width, columella length and width, tip projection, and nasolabial angle were analyzed after a minimum of 2 years after surgery. These were compared with a normal, age-matched, control group. We also examined nostril symmetry and marginal nostril scars.

RESULTS

Columellar length was not statistically significantly different from that of the control group (p = 0.122442). Nasal width, columellar width, tip projection, and nasolabial angle were all significantly greater in the cleft group than normal (p < 0.001). No hypertrophied scars were found associated with the marginal rim scar.

CONCLUSIONS

Adding the Mulliken approach allows alar cartilage manipulation to be performed more easily than when using the retrograde approach alone. Tip projection and alar base narrowing are facilitated using the combined technique rather than the Mulliken approach alone. Prolabial flap manipulation is safe using this combined approach, even in cases with a severely projected premaxilla. We believe that the combined approach is safe and yields better long-term results than either technique alone.

Authors+Show Affiliations

Division of Plastic and Reconstructive Surgery, Luis Calvo Mackenna Hospital, University of Chile, School of Medicine, Santiago, Chile. cmorovic@cmet.netNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16267421

Citation

Morovic, Carmen Gloria, and Court Cutting. "Combining the Cutting and Mulliken Methods for Primary Repair of the Bilateral Cleft Lip Nose." Plastic and Reconstructive Surgery, vol. 116, no. 6, 2005, pp. 1613-9; discussion 1620-2.
Morovic CG, Cutting C. Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose. Plast Reconstr Surg. 2005;116(6):1613-9; discussion 1620-2.
Morovic, C. G., & Cutting, C. (2005). Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose. Plastic and Reconstructive Surgery, 116(6), 1613-9; discussion 1620-2.
Morovic CG, Cutting C. Combining the Cutting and Mulliken Methods for Primary Repair of the Bilateral Cleft Lip Nose. Plast Reconstr Surg. 2005;116(6):1613-9; discussion 1620-2. PubMed PMID: 16267421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining the Cutting and Mulliken methods for primary repair of the bilateral cleft lip nose. AU - Morovic,Carmen Gloria, AU - Cutting,Court, PY - 2005/11/4/pubmed PY - 2006/2/24/medline PY - 2005/11/4/entrez SP - 1613-9; discussion 1620-2 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 116 IS - 6 N2 - BACKGROUND: Since 1990, primary bilateral cleft nasal reconstruction has been focused on placing the lower lateral cartilages into normal anatomical position. Of the four major techniques in this class, the Cutting (i.e., retrograde) method and the Mulliken method have been most successful. The retrograde method makes no external nasal incisions, but requires either preoperative or postoperative nasal molding to achieve maximum benefit. Mulliken's technique does not require molding, but leaves the footplates of the medial crura in the depression above the projecting premaxilla associated with the diminutive anterior nasal spine. Leaving the footplates in place also prevents adequate approximation of the alar bases. In this article, the two methods are combined to achieve the benefits of both. METHODS: We report our experience with the retrograde nasal approach associated with marginal rim incisions (Mulliken method) in a series of 25 consecutive bilateral cleft lip cases simultaneous with lip repair. We performed a retrograde approach through membranous septum incisions elevating a prolabial-columellar flap. To facilitate alar cartilage manipulation we added bilateral marginal rim incisions. Nasal width, columella length and width, tip projection, and nasolabial angle were analyzed after a minimum of 2 years after surgery. These were compared with a normal, age-matched, control group. We also examined nostril symmetry and marginal nostril scars. RESULTS: Columellar length was not statistically significantly different from that of the control group (p = 0.122442). Nasal width, columellar width, tip projection, and nasolabial angle were all significantly greater in the cleft group than normal (p < 0.001). No hypertrophied scars were found associated with the marginal rim scar. CONCLUSIONS: Adding the Mulliken approach allows alar cartilage manipulation to be performed more easily than when using the retrograde approach alone. Tip projection and alar base narrowing are facilitated using the combined technique rather than the Mulliken approach alone. Prolabial flap manipulation is safe using this combined approach, even in cases with a severely projected premaxilla. We believe that the combined approach is safe and yields better long-term results than either technique alone. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/16267421/Combining_the_Cutting_and_Mulliken_methods_for_primary_repair_of_the_bilateral_cleft_lip_nose_ L2 - http://Insights.ovid.com/pubmed?pmid=16267421 DB - PRIME DP - Unbound Medicine ER -