The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts

Abstract

Objective To compare effects of secondary cleft procedures on alar base position and nostril morphology. Design Retrospective review. Setting Multidisciplinary cleft clinic at tertiary center. Patients, Participants Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Interventions Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Main Outcome Measures Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Results Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base ( P < .001), increased vertical lip dimension ( P < .001), and decreased nostril height ( P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support ( P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view ( P < .04). Conclusions Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.