Primary Repair of Bilateral Complete Cleft Lip Nasal Deformity: Iraqi Experience

Background: Simultaneous surgical correction of bilateral cleft lip nasal deformity is becoming more common. This is a major change from the conventional strategy of secondary nasal correction. Many studies had concluded that primary nasal repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. Aim: This study was conducted to document the pattern of primary nasal repair in bilateral complete cleft lip deformity and to evaluate the medium term outcome. Method: A total of 13 babies with bilateral complete nasolabial clefts underwent simultaneous nasal correction with their lip closure. Mean age was 4 months. The study was performed between March 2006 and April 2009. Alar cartilage manipulation using combined Mulliken - Cutting retrograde nasal approach was performed for all cases. Results: The average follow up periods were 3 years (ranging from 6 months – 6 years).The results were evaluated by comparing 3 nasal anthropometric measurements with those of normal, age-matched children pre and postoperatively at 3 months and then yearly till 3 years. The selected nasal anthropometric measurements were: nasal tip projection, columellar length, and interalar distance. Nasal tip projection and columellar length were normal or near normal in 5 babies but slightly shorter than in control group in 8 babies. The interalar distance was near normal in 9 babies but moderately wider than in control group in 4 babies. In one case, partial prolabial flap necrosis occurred and was revised successfully 6 months later. In another 2 cases, a hypertrophic scar formed on the upper lip which subsided after 6 months of scar management. Over all nasal tip shapes were improved in all cases with acceptable nostrils asymmetry. Conclusions: In cases where presurgical molding is not available, a combined Mulliken-Cutting approach is advisable for obtaining a reasonable primary nasal repair in bilateral complete cleft lip deformity. It is not advisable to create a philtral dimple with a deep dermal suture at the prolabial flap as it may compromise the blood supply. Alar dome suspension stitches might be useful for further improvement of alar dome projection. A long follow-up is needed to observe nasal growth over time and detail final outcomes.