xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Jayarajan et al

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which has reported that the symmetry achieved is not altered by adolescent growth and growth as such is unaffected. The retrospective study by Chang et al. (2010) on 76 cases is 4 different approaches to the management of unilateral cleft lip nose which the senior author has evolved over time. All groups had postoperative nasal splints for 6 months. Except group I, which underwent rhinoplasty with bilateral rim incisions, all other groups have NAM. Group II had only NAM and no rhinoplasty. The difference between group III and IV is that IV had Tajima incision and overcorrection of the nostril (increased height and narrow width) on the cleft side. The post operative splinting in this group was also augmented during subsequent visits to maintain the overcorrection. Follow-up assessment done 5 years after the intervention using photo graphic records and measurement of 6 parameters for the nose and a panel assessment showed statistically significant results in favor of group IV in 5 of the 6 parameters and the panel assessment score also scored group IV the best. Overcorrection of the cleft nostril by 20 % through a Tajima incision has given the best results long term. Primary nose correction described as a part of their center’s integrated concepts for reconstruction by Chowchuen et al. (2010) is carried out using bilateral rim incisions, slightly higher on cleft side. Assessment of the results on 122 patients carried out by 2 plastic surgeons on nasal symmetry is given as a less satisfactory score compared to other 5 parameters for the lip. The case series by Thomas (2009) is a 14-year follow-up of 255 cases of unilateral complete cleft lip repaired by Harashina technique. This is a completely open technique with rim inci sions and a columella incision which on closure leaves a scar at the philtrum–columella junction. Evaluation of the follow-up results is with photographs and reported as excellent with no trauma to the nasal cartilage complex. The earlier follow-up series from the same author (Thomas and Mishra, 2000) of 69 cases included both unilateral and bilateral cases. The series by Ahuja (2006) consisted of 35 cases which underwent a limited open rhinoplasty with Tajima incision with rim incision on cleft side and rim incision on noncleft side with a mean follow-up of 18 months. Assessment was done by col leagues based on 5 parameters for the nose and results rated as excellent in 20 % and very good in 48.5 % . No intermediate rhinoplasty was required in his series and 40 % did not require definitive rhinoplasty. Trott and Mohan (1993) in their study on 15 complete cases of cleft lip using open rhinoplasty with Harashina’s technique evaluated by photographic documentation after 6 months reports that the technique has the potential to maintain perma nent anatomical repositioning of alar cartilage. The senior author found the early results with this method were consis tently better than that obtained previously when he had used primary closed rhinoplasty. Open rhinoplasty is technically more demanding during pri mary cleft lip repair in an infant. A complete open method has been followed only in 2 of the above studies. All have achieved good results with fewer cases requiring a secondary procedure, and when required, the residual deformities being much easier

Lonic et al. (2016) is a retrospective comparative study of closed technique with overcorrected technique using a Tajima on the cleft side. On a follow-up assessment of the results at 12 months, a statistically significant difference favoring the overcorrected group has been reported in terms of nostril and ala height. Kluba et al. (2015) in a prospective study of 79 cases using Tennison-Randall repair with primary rhinoplasty (details of the rhinoplasty not reported; e-mail query regarding this was unanswered) evaluated the results after 4 years using indirect 2 D photogrammetry. They managed to almost eliminate nasal asymmetry. The problematic area reported was nostril axis. A retrospective study of 23 cases by Margulis et al. (2014) on cleft lip repair with primary nose repair by closed technique with Tajima suture is mainly an assessment of upper lip with only 1 of the 5 anatomical parameters used for the nose-nasal sill width. Minimal difference (less than 10 % ) between the healthy and corrected sides was seen on quantitative analysis after 1-year follow-up. In the series by Rottgers and Jiang (2010), Tajima incision with semipermanent buried suture on the cleft side followed up after 9 months has been reviewed with images. They have commented that adequate cartilage repositioning was achieved and there is improvement in nasal symmetry with slight over correction noted at follow-up. Kim et al. (2004) have done a comparison between cleft lip repair with no rhinoplasty and lip repair and rhinoplasty using alar rim incision and Tajima suture on cleft nostril. Of the 412 patients in this series, 195 had no rhinoplasty (1992-1997) and 217 underwent rhinoplasty (1997-2001). Follow-up was done at 6 months and 3 years of age. Analysis was performed using photographs and anthropometric measurements of 3 para meters in 30 random children from each group and 60 random normal children. The author concludes that in Asian patients repair of nose with cleft lip provided more symmetry of nostril and nasal dome projection in comparison to children who have not undergone primary rhinoplasty. In their series, the differ ence in postoperative anthropometric measurement between patients receiving primary nasal correction and normal children was not significant. McComb has done a 10-year (McComb, 1985) and later 18-year follow-up (McComb and Coghlan, 1996) on his first 10 cases of closed technique. These patients at 18 years of age had photographs taken and computer-based measurement and analysis of nasal asymmetry done. The final long-term follow-up showed no recurrence of drooping of nostril rims or nostril flare and adolescent growth spurt had not altered the overall nasal symmetry. The techniques used for closed rhinoplasty in the studies included, varies considerably. This is probably due to a multi tude of techniques and modifications available and is a matter of surgeon preference rather than proven eminence of tech nique. All the procedures have succeeded in achieving improvement in appearance and symmetry, some more than others. But long-term follow-up is lacking except for the McComb publication with 18-year follow-up assessment,