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Assessment of secondary cleft rhinoplasty using resorbable plates at the age of primary school.
J Craniofac Surg 2009; 20 Suppl 2:1801-5JC

Abstract

BACKGROUND

Secondary rhinoplasty after a cleft lip repair remains a significant challenge. We have developed a technique in which resorbable plates are used to support the cleft alar cartilage to minimize relapse. There are few guidelines by which one can objectively assess the outcome of cleft rhinoplasty over time. This study attempts to demonstrate a means by which the symmetry and form of the proposed rhinoplasty technique can be evaluated.

METHODS

Sixteen patients with unilateral cleft lip/palate repair had a secondary rhinoplasty performed at age 6 to 8 years, using a resorbable plate (resorption time, 2-3 years) placed between the nasal lining and cleft alar cartilage to simulate the shape of the noncleft cartilage. Photographs were taken preoperatively and postoperatively. Median follow-up was 9.6 +/- 2.8 months. Various angles and ratios were measured to demonstrate outcomes, comparing preoperative to postoperative measures, and symmetry between cleft and noncleft sides.

RESULTS

Postoperatively, the angle between the horizontal axis, drawn across the alar base and tangent to the alar rim on both sides, was significantly altered (P < 0.001); both sides were closer to 60 degrees (mean, 56.28 degrees), approximating the angle of the aesthetic norm. A measure of the angle between the horizontal axis and a line drawn from midpoint of axis to nasal tip was significantly closer to 90 degrees (P < 0.05). The shape of the affected nostril became more oval and symmetric relative to the unaffected side (P < 0.05). Angle between the horizontal axis and a line drawn through the widest point of each nostril was close to zero. (P < 0.001). The difference in nostril height between the cleft and noncleft sides was significantly decreased (P < 0.001).

CONCLUSION

We have objectively evaluated the outcomes of our technique of secondary cleft rhinoplasty using resorbable plates for alar support. A careful geometric evaluation of preoperative and postoperative photographs can help determine the symmetry and overall quality of the result. These measures may help to evaluate long-term outcomes of cleft rhinoplasty over time.

Authors+Show Affiliations

Department of Plastic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA. arun.gosain@uhhospitals.orgNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19816353

Citation

Gosain, Arun K., and Amir H. Fathi. "Assessment of Secondary Cleft Rhinoplasty Using Resorbable Plates at the Age of Primary School." The Journal of Craniofacial Surgery, vol. 20 Suppl 2, 2009, pp. 1801-5.
Gosain AK, Fathi AH. Assessment of secondary cleft rhinoplasty using resorbable plates at the age of primary school. J Craniofac Surg. 2009;20 Suppl 2:1801-5.
Gosain, A. K., & Fathi, A. H. (2009). Assessment of secondary cleft rhinoplasty using resorbable plates at the age of primary school. The Journal of Craniofacial Surgery, 20 Suppl 2, pp. 1801-5. doi:10.1097/SCS.0b013e3181b5d4c0.
Gosain AK, Fathi AH. Assessment of Secondary Cleft Rhinoplasty Using Resorbable Plates at the Age of Primary School. J Craniofac Surg. 2009;20 Suppl 2:1801-5. PubMed PMID: 19816353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of secondary cleft rhinoplasty using resorbable plates at the age of primary school. AU - Gosain,Arun K, AU - Fathi,Amir H, PY - 2009/10/10/entrez PY - 2009/12/25/pubmed PY - 2010/5/5/medline SP - 1801 EP - 5 JF - The Journal of craniofacial surgery JO - J Craniofac Surg VL - 20 Suppl 2 N2 - BACKGROUND: Secondary rhinoplasty after a cleft lip repair remains a significant challenge. We have developed a technique in which resorbable plates are used to support the cleft alar cartilage to minimize relapse. There are few guidelines by which one can objectively assess the outcome of cleft rhinoplasty over time. This study attempts to demonstrate a means by which the symmetry and form of the proposed rhinoplasty technique can be evaluated. METHODS: Sixteen patients with unilateral cleft lip/palate repair had a secondary rhinoplasty performed at age 6 to 8 years, using a resorbable plate (resorption time, 2-3 years) placed between the nasal lining and cleft alar cartilage to simulate the shape of the noncleft cartilage. Photographs were taken preoperatively and postoperatively. Median follow-up was 9.6 +/- 2.8 months. Various angles and ratios were measured to demonstrate outcomes, comparing preoperative to postoperative measures, and symmetry between cleft and noncleft sides. RESULTS: Postoperatively, the angle between the horizontal axis, drawn across the alar base and tangent to the alar rim on both sides, was significantly altered (P < 0.001); both sides were closer to 60 degrees (mean, 56.28 degrees), approximating the angle of the aesthetic norm. A measure of the angle between the horizontal axis and a line drawn from midpoint of axis to nasal tip was significantly closer to 90 degrees (P < 0.05). The shape of the affected nostril became more oval and symmetric relative to the unaffected side (P < 0.05). Angle between the horizontal axis and a line drawn through the widest point of each nostril was close to zero. (P < 0.001). The difference in nostril height between the cleft and noncleft sides was significantly decreased (P < 0.001). CONCLUSION: We have objectively evaluated the outcomes of our technique of secondary cleft rhinoplasty using resorbable plates for alar support. A careful geometric evaluation of preoperative and postoperative photographs can help determine the symmetry and overall quality of the result. These measures may help to evaluate long-term outcomes of cleft rhinoplasty over time. SN - 1536-3732 UR - https://www.unboundmedicine.com/medline/citation/19816353/Assessment_of_secondary_cleft_rhinoplasty_using_resorbable_plates_at_the_age_of_primary_school_ L2 - http://Insights.ovid.com/pubmed?pmid=19816353 DB - PRIME DP - Unbound Medicine ER -