Triangular with Ala nasi (TAN) repair of unilateral cleft lips: a personal technique and early outcomes

The triangular flap repair is one of the most common techniques used in cleft lip surgery. However, inability to address the nasal deformity and loss of orbicularis wholeness accompanied with incomplete reorientation have been two major handicaps of the triangular repair. Therefore, we developed our personal technique, called the triangular with ala nasi (TAN) repair, including a perialar incision and a distinct approach to the skin and muscle. We applied the TAN technique to 32 consecutive (19 male and 13 female) patients with unilateral cleft. The mean age at repair was 2.5 (1-32) years. The cleft lip appeared completely and incompletely in 11 and 21 patients, respectively. The postoperative outcomes were assessed subjectively by Williams test and objectively by Lindsay-Farkas method.The mean follow-up time was 17.1 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. The recoveries of 79.1% and 86.2% on average, when compared with the noncleft side, were obtained postoperatively. With our technique, we aimed at combining the useful properties of the two popular techniques, Millard and Tennison-Randall. The TAN repair lengthens the vertical lip using a triangular flap, resulting in a nonlinear, zig-zag scar on the philtral ridge and forming a symmetrical cupid's bow, superiorities of the Tennison-Randall repair. On the other hand, our method also presents an excellent approximation of both the deep and superficial muscle groups and reduces the nasal deformity with a perialar incision, features of the Millard's technique.