10 years follow-up of 60 cleft lip patients treated for secondary nasal defects

The purpose is to evaluate the long term results of 60 of 180 patientstreated with an "Anatomical Balance" method of secondary nasal correction,which means detouch and dismount progressively the septum,the alar cartilages, the bone vault and finally the soft tissues for thenre-build and re-orient and, if necessary, graft the nose structure withautologous material (1-2). 60 patients treated from 1993 to 2002, 39mono and 21 bi-lateral, medium age 24.5 years. Our procedures weredirected to the nasal tip, preserving and re-orienting the nasal structureswith an open approach and applying a personal technique called BCRCC(3) (14% of the patients), re-modelling and re-positioning of the domes(90% of the cases). Cartilage and bone have been used as grafts in80% of our patients The follow-ups made on our 60 patients after 1 to10 years seem to support the results that guarantee a better shaping ofthe tip without the need of a second surgical time. No major immediateand long term complication was observed except columellar scars (4%Symmetry and nasal function improved in all our cases (98.9%). Overthe years the first surgical step in cleft li patients has been the correctionof the lip, and then the remaining structures (Salyer 1992, Chase 1983,Mulliken 1992). Finally we can conclude that the primary treatment isof the lip-nasal deformity (Gubisch 1995, Salyer 2004). The treatmentof secondary nasal defects with the "anatomical Balance" method givean improvement of the tip projection by means of various techniques,one of them to be known as the Bilateral Controlateral Rotation of theupper Cephalic segment of the lateral Crura (BCRCC) (Nocini et al 2001)avoiding further surgical treatments.References[1] J.B. Mulliken, M.D.: "Principles and Techniques of Bilateral Complete CleftLip Repair". Plast. Reconstr. Surg. Vol. 75, N O 4: 477-486, April 1985.[2] C. Cutting, et AI..: "Presurgical Columellar Elongation and Primary Retrogradenasal Reconstruction in One-Stage Bilateral Cleft lip and NoseRepair". Plast. Reconstr. Surg. Vol. 101, N O 3: 630-639, March 1998.[3] EF. Nocini, G.N. Trenite, D. Bertossi: 'q-he correction of the tip in cleftlip secondary rhinoplasty: bilateral controlateral rotation of the cephalicsegment of the lateral crura (BCRCC)". Face vol. 7 no1 pp 13-20 2001.4) Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair -long-term outcome. Clin Plast Surg. 2004 Apr;31(2):191-208. Review.