"Alar leapfrog". A technique for repositioning the total alar cartilage at primary cleft lip repair

A technique is described to reconstruct the normal degree of projection of the alar dome of the unilateral cleft lip nose by leapfrogging the spreadeagled alar cartilage up onto the back of the sturdy septum and upper lateral cartilage arch. The medial crus enclosed in a hemiforked flap slides along the membranous septal incision; the lateral crus slides along the intercartilaginous incision; they join each other as the stem of a Y, where they are secured in their new relationship to the septum and upper lateral cartilage. As the limbs approach each other, a standing cone creates the dome projection externally and a fornix within. The dipped rim rises and the charming nasal dimple reappears. Almost 200 primary cases of unilateral cleft lip nose have been treated by this technique over the past 12 years by the author. Alar dome and alar rim relapse have been infrequent. Less than 5 per cent of patients (or parents) have requested revision up to puberty. Final assessment of the effect of this radical surgery may well require a further 10 years' follow-up.