Costal cartilage spring graft for late correction of cleft lip nose deformity: new technique

Abstract

Background: Late correction of cleft lip nose deformity continues to be a challenge because of the weakness of cartilages and the collapsing forces of tight contracted soft tissues. The authors describe the new technique of costal cartilage spring graft for columella and lower lateral cartilage as a block to achieve symmetric, aesthetically more durable, and acceptable results for the late correction of cleft lip nose deformity. Methods: Late cleft lip nose repair with simultaneous rhinoplasty was performed in 92 patients with unilateral cleft lip nose deformity. For correction of cleft lip nose deformity, a strut graft 2 to 3 mm in width, 0.5 to 1 mm in thickness, and 5 to 7 cm in length was prepared from costal cartilage (autograft or allograft). The strut graft was curved and bowed with fingers to simulate the medial and lateral crura of the alar cartilage. A crescent-shaped skin excision from the alar rim and a vertical incision in the columella were made. The intercrural and alar areas were dissected to create sufficient space for the insertion of a bow-shaped spring cartilage graft. After insertion of the cartilage graft, the alar rim was closed with continuous 6-0 Monocryl and the columella was closed with 5-0 Vicryl. Results: Correction of depressed alar cartilage and webbing, lengthening the columella using spring costal cartilage, and symmetric nostrils were achieved in all cases. The mean follow-up period was 5 years (range, 2 to 15 years). Conclusion: These procedures, septoplasty, and simultaneous rhinoplasty provided long-term satisfactory results in the late correction of cleft lip nose deformity.