Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique

Khaled Alkebsi; Yaser Abdo; Bassam Abotaleb; Karim Ahmed Sakran; Bing Shi; Chenghao Li

doi:10.1016/j.bjps.2023.10.099

Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique

J Plast Reconstr Aesthet Surg. 2023 Oct 20:S1748-6815(23)00668-X. doi: 10.1016/j.bjps.2023.10.099. Online ahead of print.

Authors

Khaled Alkebsi¹, Yaser Abdo², Bassam Abotaleb¹, Karim Ahmed Sakran¹, Bing Shi³, Chenghao Li⁴

Affiliations

¹ State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen.
² Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen; School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, China.
³ State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: shibingcn@vip.sina.com.
⁴ State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: leechenghao_cn@yahoo.com.

PMID: 39788846
DOI: 10.1016/j.bjps.2023.10.099

Abstract

Background: Improving growth-related nasal stability is a critical goal of primary cleft lip repair. The purpose of this study was to evaluate the growth-related stability of the nose after unilateral complete cleft lip (UCCL) repair with standard rotation-advancement (RA) and modified rotation-advancement (MRA) techniques.

Material and method: In this retrospective study, 52 non-syndromic (UCCL) patients were treated with a MRA technique, where a C-flap and a superiorly based advanced flap were used to lengthen and support the columella and nasal sill, and 48 patients were treated with a standard RA technique. Photos were taken before surgery (T1), immediately after surgery (T2), 1 year after surgery (T3), and 5 years after surgery (T4). Cleft width ratio, maxillary discrepancy, ala collapse, ala base position, columellar angle and height, nostril height, and width were all measured. The t-test, repeated-measure analysis of variance (ANOVA), stepwise multiple regression, inter-class correlation coefficient, and ANOVA with Bonferroni corrections were conducted.

Results: MRA improved columellar height significantly at T3 and T4. Growth-related columellar height stability at T2-T4 was significantly better in the MRA group (P = 0.08) than in the standard RA group (P = 0.007). Nasal width was a moderate predictor of post-operative outcome, and maxillary discrepancy and ala collapse were moderate predictors of growth-related nostril height changes.

Conclusion: Both groups demonstrated the same measurement stability at 1 and 5 years, except for the columellar height in the standard RA group, which deteriorated and then improved over time due to unknown reasons. Furthermore, the MRA group had better columellar height symmetry than the standard RA group at 1 and 5 years after surgery.

Keywords: Columellar angle; Columellar height; Growth-related nasal stability; Rotation-advancement; Unilateral complete cleft lip.