Isolated naso-ocular cleft: a one-stage repair

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Naso-ocular clefts are rare congenital anomalies.
• Isolated alar clefts, with or without hamartomatous tissue, represent an even rarer subset of these defects.
• Existing repair strategies often address soft tissue deficiency, but malpositioning may be a primary issue.

Purpose of the Study:

• To describe a surgical technique for repairing isolated alar clefts.
• To evaluate the efficacy of a rotation advancement flap combined with a paranasal transposition flap for alar cleft reconstruction.
• To highlight the challenges and outcomes in cases with associated hamartomatous tissue.

Main Methods:

• A cohort of seven patients (six unilateral, one bilateral) with isolated alar clefts underwent surgical repair.
• The core principle involves rotation advancement of medial and lateral segments adjacent to the cleft to recreate the alar rim.
• A paranasal transposition flap was utilized to close the secondary defect created by the flap advancement.

Main Results:

• The described technique was applied to all seven patients for initial repair.
• Three patients presented with hamartomatous excesses, posing greater reconstructive challenges.
• Two patients with hamartomatous tissue required secondary procedures involving free conchal cartilage grafts for augmentation or bridging.

Conclusions:

• The described rotation advancement technique offers a viable approach for correcting isolated alar clefts by addressing tissue malpositioning.
• While effective for primary repair, cases with significant hamartomatous tissue may necessitate secondary cartilage grafting.
• This method emphasizes reconstructive principles focused on repositioning existing tissue for alar rim reconstruction.