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The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts.
Plast Reconstr Surg. 2007 Nov; 120(6):1633-40.PR

Abstract

BACKGROUND

Septal deviation and alar cartilage deformities constitute an important component of both the aesthetic deformity and airway compromise in unilateral cleft lip nose deformity. The purpose of this study was to examine the retrocolumellar preseptal area in this deformity for evaluation of deforming forces in the adult population.

METHODS

Fifty-five patients aged 13 years or older presenting with unilateral cleft nasal deformity were included. The caudal border of the septum was accessed using an incision along the ipsilateral membranous septum. Perioperatively, the curved caudal septal edge was exposed and explored down to its attachment with the hypertrophied anterior nasal spine. The overlying tethering tissues were excised and submitted for histopathologic examination. The curved septal cartilage was straightened and the misplaced anterior nasal spine was excised. The remaining cleft nasal deformity was corrected depending on the specific presenting pathologic abnormality.

RESULTS

A well-defined, tough, fibrous band was detected extending from the deviated curved surface of the septal cartilage to the anterior nasal spine that was filling up the retrocolumellar area. Histopathologic examination revealed fibrous tissue in all cases studied, consistent with diagnosis of a ligament. Postoperatively, the nasal tip complex cosmetic result was considered to be good or very good in 89.7 percent, satisfactory in 8.1 percent, and poor in 2.0 percent of patients.

CONCLUSIONS

A well-defined ligament has been documented and demonstrated in adult patients with unilateral cleft lip nose deformity. The authors recommend that this septospinal ligament, previously unreported, should be excised in toto to achieve straightening of the septum, columellar centralization, and nasal sill symmetry in unilateral cleft lip nose deformity.

Authors+Show Affiliations

Postgraduate Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow, India. drrajivagarwal@rediffmail.comNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18040198

Citation

Agarwal, Rajiv, and Ramesh Chandra. "The Septospinal Ligament in Cleft Lip Nose Deformity: Study in Adult Unilateral Clefts." Plastic and Reconstructive Surgery, vol. 120, no. 6, 2007, pp. 1633-40.
Agarwal R, Chandra R. The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts. Plast Reconstr Surg. 2007;120(6):1633-40.
Agarwal, R., & Chandra, R. (2007). The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts. Plastic and Reconstructive Surgery, 120(6), 1633-40.
Agarwal R, Chandra R. The Septospinal Ligament in Cleft Lip Nose Deformity: Study in Adult Unilateral Clefts. Plast Reconstr Surg. 2007;120(6):1633-40. PubMed PMID: 18040198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts. AU - Agarwal,Rajiv, AU - Chandra,Ramesh, PY - 2007/11/28/pubmed PY - 2007/12/28/medline PY - 2007/11/28/entrez SP - 1633 EP - 40 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 120 IS - 6 N2 - BACKGROUND: Septal deviation and alar cartilage deformities constitute an important component of both the aesthetic deformity and airway compromise in unilateral cleft lip nose deformity. The purpose of this study was to examine the retrocolumellar preseptal area in this deformity for evaluation of deforming forces in the adult population. METHODS: Fifty-five patients aged 13 years or older presenting with unilateral cleft nasal deformity were included. The caudal border of the septum was accessed using an incision along the ipsilateral membranous septum. Perioperatively, the curved caudal septal edge was exposed and explored down to its attachment with the hypertrophied anterior nasal spine. The overlying tethering tissues were excised and submitted for histopathologic examination. The curved septal cartilage was straightened and the misplaced anterior nasal spine was excised. The remaining cleft nasal deformity was corrected depending on the specific presenting pathologic abnormality. RESULTS: A well-defined, tough, fibrous band was detected extending from the deviated curved surface of the septal cartilage to the anterior nasal spine that was filling up the retrocolumellar area. Histopathologic examination revealed fibrous tissue in all cases studied, consistent with diagnosis of a ligament. Postoperatively, the nasal tip complex cosmetic result was considered to be good or very good in 89.7 percent, satisfactory in 8.1 percent, and poor in 2.0 percent of patients. CONCLUSIONS: A well-defined ligament has been documented and demonstrated in adult patients with unilateral cleft lip nose deformity. The authors recommend that this septospinal ligament, previously unreported, should be excised in toto to achieve straightening of the septum, columellar centralization, and nasal sill symmetry in unilateral cleft lip nose deformity. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/18040198/The_septospinal_ligament_in_cleft_lip_nose_deformity:_study_in_adult_unilateral_clefts_ L2 - http://Insights.ovid.com/pubmed?pmid=18040198 DB - PRIME DP - Unbound Medicine ER -