Rotational Composite Flap Technique for Primary Incomplete Cleft Lip Nose Repair

Primary cheilorhinoplasty has become widely accepted owing to evidence of improved outcomes and need for fewer secondary revisions. The rotational advancement concept was described initially as a secondary treatment for cleft nasal deformity in combination with buccal mucosal graft for the donor site. The presented technique is based on medial rotation of a vestibular flap composed by the alar cartilage and skin without donor site grafting and has been used by the author since 2016. The aim of this study is to evaluate the long-term outcomes of this unilateral primary cleft rhinoplasty technique.

This is a retrospective cross-sectional study. Patients with unilateral incomplete cleft lip were operated between 2016 and 2018 using the rotational composite flap rhinoplasty and followed during at least 5 years to evaluate nasal symmetry. Nose surgical outcomes were analyzed using photographic records and rated by 3 observers. Photographs of frontal and basilar views (1:1) under standardized conditions were used.

Eighty-five patients with unilateral incomplete cleft lip have been operated by the author since 2016, and the median age at the time of surgery was 3.8 months. Total nostril height symmetry was observed in 35 of 49 (71.42%) and total lip width symmetry in 38 of 49 (77.55%).

The rotational composite flap method for unilateral primary cleft rhinoplasty is described. Low number of these patients required additional surgical correction at the mixed dentition period time. Longer follow-up and comparative studies are required to confirm these findings.