Alar base flap and suspending suture: a strategy to restore symmetry to the nasal alar contour in primary cleft-lip rhinoplasty.

OBJECTIVE: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. We describe the mechanism and contribution of different surgical techniques to restore alar symmetry in primary cleft-lip rhinoplasty.

STUDY DESIGN: We evaluate surgical results using a retrospective, randomized, blinded surgical grading system. We describe a surgical technique designed to restore nasal symmetry in patients undergoing primary cleft-lip rhinoplasty. Patients were selected retrospectively.

METHODS: A series of patients were identified with nasal asymmetry associated with cleft-lip deformity. All patients underwent cleft-lip repair with concurrent primary cleft-lip rhinoplasty. Patients who underwent alar base flap suspending suture (ABF-SS) were grouped and selected consecutively after a modification in the senior author's surgical technique. A control group was matched for age, sex, and cleft characteristics. Primary rhinoplasty was carried out concurrently for both study groups while undergoing unilateral cleft-lip repair. The control group did not undergo the described ABF-SS technique. All patients were operated on by the same surgeon over a period of 5 years. Surgical outcomes were evaluated by a panel including lay people as well as trained health care workers experienced in the critical evaluation of esthetic results after cleft-lip rhinoplasty.

RESULTS: Forty-six records were reviewed of patients undergoing complete unilateral cleft-lip repair. After applying strict inclusion/exclusion criteria, nine patients underwent the described ABF-SS technique. All patients in the preoperative group had a clinically and statistically comparable degree of deformity (P > .05). There was a clinical and statistically significant improvement in nostril size, shape, symmetry, alar base symmetry, and nasal tip/dome symmetry for patients undergoing repair with the described technique compared with the control group. No clinical or statistically significant difference was observed in the scarring scores between groups.

CONCLUSIONS: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. Execution of the described surgical techniques restores nasal alar symmetry in patients undergoing concurrent primary cleft-lip rhinoplasty.