A Modified V-Y Chondromucosal Composite Flap for Correction of Secondary Cleft Nasal Deformity: Photogrammetric Analysis of a Case-Control Study

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Abstract

Background:

Secondary cleft nasal deformity is a combination of the inherent cleft defects and the effects of operations to address the primary nasal deformity. The authors revisited a modified V-Y chondromucosal flap to restore symmetric nostril shape and balanced tip projection.

Methods:

A retrospective case-control study of the senior author’s (J.A.T.) experience with secondary cleft tip rhinoplasty using the V-Y chondromucosal flap was conducted. Preoperative and postoperative anteroposterior and worm’s-eye photographs were compared by means of photogrammetric analysis. Results were compared with those of controls who had not undergone surgery. Interrater reliability was assessed using the Pearson coefficient.

Results:

Seventeen cases and 24 controls were reviewed. Average age at repair was 9.3 ± 3.6 years; average follow-up was 13 months. Interrater reliability was 0.98 overall. Photogrammetric analysis demonstrated postoperative increases in cleft-side columella length by 2.3 mm (p = 0.0001) and nasal apex height by 1.3 mm (p = 0.003); non–cleft-side measurements were statistically unchanged. Control measurements were similar across 1-year visit interval, and when compared with cases, patients undergoing tip rhinoplasty had significantly different cleft-side columella length postoperatively (increase of 2.31 mm versus 0.15 mm; p = 0.0002) and nasal apex height (increase of 1.29 mm versus 0.17 mm; p = 0.03). All other parameters remained comparable. No complications and no external nasal valve collapse were observed.

Conclusions:

In select patients, use of a V-Y chondromucosal flap increased cleft-side nasal tip projection and columellar height, improving overall nasal tip appearance. Although absolute width of the cleft alar base is unchanged, the cleft-side nostril is qualitatively more symmetric postoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.

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