Lateral crus graft with autologous rib cartilage for cleft lip nostril asymmetry: a report of 35 cases

Abstract

A surgical technique of lateral crus strut graft to correct the deformity of nostril contour and improve asymmetric nostril shape by autologous rib cartilage was reported. Thirty-five patients (20 males and 15 females), with a mean age of 19 years (range of 16–26 years) were included in this study. All of the patients suffered moderate to severe unilateral cleft lip nostril deformity and underwent surgical technique of lateral crus strut graft by autologous rib cartilage to correct the asymmetric nostril contour from 2010 to 2012. The views of the nostril contour on both sides were reviewed and some parameters were measured at different time points (preoperatively, and 3 months and one year postoperatively) including the long axis and short axis of the nostrils. The differences in nostrils including long axis, short axis, elliptical area and eccentricity on the both sides were compared at different time points. The differences in the long axis and eccentricity of the nostrils on the two sides were decreased significantly between the preoperative view and postoperative view (P<0.05). The surgical technique of lateral crus graft with autologous rib cartilage is effective to correct the abnormal nostril contour and improve the asymmetry for unilateral cleft clip patients.

Keywords

cleft lip / rib cartilage / nostril

References

[1] DemirserenME, OhkuboF, KadomatsuK, et al.. A simple method for lower lateral cartilage repositioning in cleft lip nose deformity. Plast Reconstr Surg, 2004, 13(2): 649-652

[2] NagyK, MommaertsMY. Analysis of the cleft-lip nose in submental-vertical view, Part I—reliability of a new measurement instrument. J Craniomaxillofac Surg, 2007, 35(6–7): 265-277

[3] GuyuronB. MOC-PS(SM) CME article: late cleft lip nasal deformity. Plast Reconstr Surg, 2008, 121(4Suppl): 1-11

[4] PawarSS, WangTD. Secondary cleft rhinoplasty. JAMA Facial Plast Surg, 2014, 16(1): 58-63

[5] AngelosP, WangT. Revision of the cleft lip nose. Facial Plast Surg, 2012, 28(4): 447-453

[6] CohenM, MorrisDE, WhiteAD, et al.. Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities. Indian J Plast Surg, 2009, 42Suppl: S91-S101

[7] ByrdHS, El-MusaKA, YazdaniA. Definitive repair of the unilateral cleft lip nasal deformity. Plast Reconstr Surg, 2007, 120(5): 1348-1356

[8] LiAQ, SunYG, WangGH, et al.. Anatomy of the nasal cartilages of the unilateral complete cleft lip nose. Plast Reconstr Surg, 2002, 109(6): 1835-1838

[9] FomonS, GilbertJG, CaronAL, et al.. Collapsed ala. Arch Otolaryngol Head Neck Surg, 1950, 51: 465-484

[10] JangYJ, MinJY, LauBC, et al.. A multilayer cartilaginous tip-grafting technique for improved nasal tip refinement in Asian rhinoplasty. Otolaryngol Head Neck Surg, 2011, 145(2): 217-222

[11] SykesJM, JangYJ. Cleft lip rhinoplasty. Facial Plast Surg Clin North Am, 2009, 17(1): 133-144

[12] HafeziF, NaghibzadehB, AshtianiAK, et al.. Correction of cleft lip nose deformity with rib cartilage. Aesthet Surg J, 2013, 33(5): 662-673

[13] WulkanM, SáAJ, AlonsoN. Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages. Acta Cir Bras, 2012, 27(10): 713-719

[14] BruintjesTD, van OlphenAF, HillenB, et al.. A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area. Laryngoscope, 1998, 108(7): 1025-1032

[15] Ortiz-MonasterioF, OlmedoA, OscoyLO. The use of cartilage grafts in primary aesthetic rhinoplasty. Plast Reconstr Surg, 1981, 67: 597-605

[16] RohrichRJ, RaniereJJr, HaRY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg, 2002, 109(7): 2495-2505

[17] GunterJP, RohrichRJ. Augmentation rhinoplasty: Dorsal on lay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg, 1990, 86(1): 39-45

[18] TardyMEJr, DennenyJ3rd, FritschMH. The versatile cartilage autograft in reconstruction of the nose and face. Laryngoscope, 1985, 95: 523-533

[19] ArslanE, MajkaC, BedenV. Combined use of triple cartilage grafts in secondary rhinoplasty. J Plast Reconstr Aesthet Surg, 2007, 60(2): 171-179

[20] BoaheneKD, HilgerPA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg, 2009, 11(5): 285-289

[21] GunterJP, FriedmanRM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg, 1997, 99: 943-952

[22] GunterJP, LandeckerA, CochranCS. Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg, 2006, 118(1): 14e-29e

[23] JungDH, ChoiSH, MoonHJ, et al.. A cadaveric analysis of the ideal costal cartilage graft for Asian rhinoplasty. Plast Reconstr Surg, 2004, 114(2): 545-550

[24] MoonBJ, LeeHJ, JangYJ. Outcomes following rhinoplasty using autologous costal cartilage. Arch Facial Plast Surg, 2012, 14(3): 175-180

[25] RomoT3rd, SclafaniAP, JaconoAA. Nasal reconstruction using porous polyethylene implants. Facial Plast Surg, 2000, 16(1): 55-61

[26] InanliS, SariM, YanikM. A new consideration of scar formation in open rhinoplasty. J Craniofac Surg, 2009, 20(4): 1228-1230

[27] KimJE, SykesJM, ShayeDA. Cleft lip and cleft rhinoplasty complications. Facial plast Surg, 2012, 28(3): 318-322

[28] ChoBC, LeeJH, CohenM, et al.. Surgical correction of unilateral cleft lip nasal deformity. J Craniofac Surg, 1998, 9(1): 20-29