Correction of Post-Cleft Lip Nostril Floor Stenosis: Para-Alar Flap Combined With Lip Revision

Abstract

Post-cheiloplasty nostril floor stenosis is a scarcely reported secondary deformity. The aim of the current study was to assess the outcome of para-alar flap for management of nostril floor stenosis post-unilateral cleft lip repair. This is a retrospective case series study reviewing consecutive patients presenting with nostril floor stenosis following repair of unilateral cleft lip who were managed by the inferiorly based para-alar flap and lip revision. Differential nostril width was measured preoperative, immediate, and late postoperative. We reported 8 patients (3 boys and 5 girls) with an average age of 9.8 years (range: 4.5-19). Satisfactory results with good nostril symmetry measures were achieved, and no restenosis has been observed during the follow-up periods. The donor site scars were negligible. There was no reported partial or total flap loss. Para-alar flap was found to be an effective reconstructive option for patients with nostril floor stenosis post-unilateral cleft lip repair and can be combined safely with cleft lip revision.

Keywords

nostril stenosis secondary deformity para-alar flap

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References

Atherton

. A descriptive anatomy of the face in human fetuses with unilateral cleft lip and palate. Cleft Palate J. 1967;4:104–414.

Aydogdu

Akan

Gideroglu

Akoz

. Alar transposition flap for stenosis of the nostril. Scand J Plast Reconstr Surg Hand Surg. 2006;40(5):311–314.

Bajaj

Bailey

. Stenosis of the nostrils: a report of three case. Br J Plast Surg. 1969;22(3):269–273.

Bernard

. Reconstruction of the burned nose and ear. Clin Plast Surg. 2000;27(1):97–112.

Blandini

Tremolada

Beretta

Mascetti

. Iatrogenic nostril stenosis: aesthetic correction using a vestibular labial mucosa flap. Plast Reconstr Surg. 1995;95(3):569–571.

Bozkurt

Kapi

Kuvat

Selcuk

. Repair of nostril stenosis using a triple flap combination: boomerang, nasolabial, and vestibular rotation flaps. Cleft Palate Craniofac J. 2012;49(6):753–758.

Bruschi

Marchesi

Boriani

Kefalas

Bocchiotti

Fraccalvieri

. Galea-including forehead flap for lower one-third nasal reconstruction. Ann Plast Surg. 2009;63(1):67–70.

Constantian

. An alar base flap to correct nostril and vestibular stenosis and alar base malposition in rhinoplasty. Plast Reconstr Surg. 1998;101(6):1666–1674.

Copcu

. Reconstruction of total and near total nostril stenosis in the burned nose with gingiva-mucosal flap. Burns. 2005;31(6):802–803.

10.

Cutting

Dayan

. Lip height and lip width after extended Mohler unilateral cleft lip repair. Plast Reconstr Surg. 2003;111(1):17–23.

11.

Daya

. Nostril stenosis corrected by release and serial stenting. J Plast Reconstr Aesthet Surg. 2009;62(8):1012–1019.

12.

Ebrahimi

Shams

. Severe iatrogenic nostril stenosis. Indian J Plast Surg. 2015;48(3):305–308.

13.

Fisher

. Unilateral cleft lip repair: an anatomical subunit approximation technique. Plast Reconstr Surg. 2005;116(1):61–71.

14.

Foda

. Nasal base narrowing: the combined alar base excision technique. Arch Facial Plast Surg. 2007;9(1):30–34.

15.

Hafezi

Karimi

Nouhi

. Aesthetic septorhinoplasty in the burned nose. Burns. 2005;31(2):223–229.

16.

Kim

Park

Jang

. Aesthetic outcomes of alar base resection in Asian patients undergoing rhinoplasty. JAMA Facial Plast Surg. 2016;18(6):462–466.

17.

Kim

Cho

Park

Jafarov

. A comparative study of the medial crura of alar cartilages in unilateral secondary cleft nasal deformity: The validity of medial crus elevation. Ann Plast Surg. 2008;61(4):404–409.

18.

La Rossa

Donath

. Primary Nasoplasty in unilateral and bilateral cleft nasal deformity. Clin Plast Surg. 1993;20(4):781–791.

19.

Sun

Wang

Zhong

Cutting

. Anatomy of the nasal cartilages of the unilateral complete cleft lip nose. Plast Reconstr Surg. 2002;109(6):1835–1838.

20.

Mauerhofer

. New operative technique to correct an almost complete nasal stenosis- case presentation. Aesth Plast Surg. 1988;12(2):85–88.

21.

Mavili

Akyurek

. Use of upper lip flap for correction of nostril stenosis. Otolaryngol Head Neck Surg. 1999;121(6):840–841.

22.

McComb

. Primary correction of unilateral cleft lip nasal deformity: a 10-year review. Plast Reconstr Surg. 1985;75(6):791–799.

23.

Meyer

. Traitement chirurgical reconstruct if des sténoses narinaires. Pract oto-rhino-laryng. 1971;33(2):140–149.

24.

Polaillon

. Rhinoplastie. Bull Mem Soc Chir. 1884;10:963–965.

25.

Suzuki

. Para-alar crescentic subcutaneous pedicle flap for repair of skin defects in the philtrum. Ann Plast Surg. 1989;23(5):442–446.

26.

Tamada

Nakajima

Ogata

Onishi

. Secondary repair of cleft lip nose deformity using subcutaneous pedicle flaps from the unaffected side. Br J Plast Surg. 2005;58(3):312–317.

27.

Yamawaki

. Para-alar crescentic subcutaneous pedicle flap for severe stenosis of anterior nares. Am J Otolaryngol. 2006;27(3):211–213.