The gull wing incision in cleft lip rhinoplasty

The deficient anatomy of the cleft lip-nasal deformity has been fairly well described and a number of surgical procedures have been offered for its correction. Access to the nasal cartilages and precise correction have remained elusive. While a number of internal and external approaches have been proposed, we feel that the gull wing incision gives us excellent exposure for simultaneous visualization of both lower lateral cartilages and places the scar at the base of the columella which seems its best hiding place. With better visualization of the lower lateral cartilages and the employment of Dibbell's cartilage strut technique, we have been able to overcorrect accurately and ultimately achieve better symmetry and more lasting improvement. We have used this approach in the unilateral and bilateral cleft lip-nasal deformity in 15 patients. Principles that have become apparent by virtue of this better exposure include: full dissection of the lateral wings of the lower lateral cartilages and overcorrection using nonabsorbable mattress sutures for cartilage positioning. Pre- and postoperative cases are presented.