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Augmentation of Pyriform Margin Using Porous High-Density Polyethylene Sheet In Unilateral Cleft Lip Nasal Deformity  

Han, Ki Hwan (Department of Plasic and Reconstructive Surgery, Keimyung University School of Medicine)
Kim, Jin Han (Department of Plasic and Reconstructive Surgery, Keimyung University School of Medicine)
Choi, Tae Hyun (Department of Plasic and Reconstructive Surgery, Keimyung University School of Medicine)
Kim, Jun Hyung (Department of Plasic and Reconstructive Surgery, Keimyung University School of Medicine)
Son, Dae Gu (Department of Plasic and Reconstructive Surgery, Keimyung University School of Medicine)
Publication Information
Archives of Plastic Surgery / v.35, no.4, 2008 , pp. 431-438 More about this Journal
Abstract
Purpose: The common deformity after the correction of unilateral cleft lip nasal deformity is nasal asymmetry, and it is caused by the hypoplasia of the pyriform aperture. To correct this, many procedures have been applied, but still many problems are present. Authors performed the inlay and onlay insertion of porous high density polyethylene sheet(1 mm thickness $Medpor{(R)}$ sheet) in the hypoplastic pyriform margin of cleft side and obtained satisfactory results. Methods: 11 cases were performed and the mean follow up period was 15.1 months. Their mean age was 23.6 years. Under general anesthesia, bilateral pyriform margin was exposed. $Medpor{(R)}$ sheets in "match stick" like shaped were inlay inserted, and kidney shaped were onlay inserted fixating with two 6 mm titanium screws. After the surgery, the results was evaluated by photogrammetric analysis. On the basal view, the distance from the subalare and labiale superius' to the transverse baseline connecting the both cheilions was measured from the cleft side and the non-cleft side. Then, the postoperative symmetry was assessed by obtaining the cleft side against the non-cleft side as proportion index, defined as lateral and medial upper lip contour index. Results: There were 2 infections. The cause was because the inserted implant was too long and thus protruded to the base of nasal cavity. The lateral upper lip contour index was from 95.49 to 103.27, and medial upper lip contour index was from 90.92 to 100.49, it was statistically increased, and thus the symmetry was improved. However clinically mild depression remained at nostril floor. Conclusion: Authors performed porous high density polyethylene sheet inlay and onlay insertion for the hypoplasia of the pyriform margin in unilateral cleft lip nasal deformity. It was found that depressed pyriform margin and upper lip were corrected effectively except for the nostril floor, for which an additional soft tissue augmentation would be necessary. The inlay insertion has risk of protrusion, thus the guideline of the use of artificial prosthesis should be observed strictly.
Keywords
: Porous high-density polyethylene; Cleft lip nasal deformity; Pyriform margin augmentation;
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1 Fisher DM, Lo LJ, Chen YR, Noordhoff MS: Three- dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate. Plast Reconstr Surg 103: 1826, 1999   DOI
2 Maisels DO: The alar base composite graft in cleft lip noses. Br J Plast Surg 31: 220, 1978   DOI
3 Farrior RT: The problem of the unilateral cleft lip nose. A composite operation for revision of the secondary deformity. Laryngoscope 72: 289, 1962
4 Longacre JJ, Halak DB, Munick LH, Johnson HA, Chunekamrai D: A new approach to the correction of the nasal deformity following cleft lip repair. Plast Reconstr Surg 38: 555, 1966   DOI
5 Ariyan S, Krizek TJ: A simplified technique for correction of the cleft lip nasal deformity. Ann Plast Surg 1: 568, 1978   DOI   ScienceOn
6 Jackson IT, Vandervord JG, McLennan JG, Christie FB, McGregor JC: Bone graft of the secondary cleft lip & palate deformity. Br J Plast Surg 35: 345, 1982   DOI
7 Huffman WC, Lierle DM: Studies on the pathologic anatomy of the unilateral harelip nose. Plast Reconstr Surg 4: 225, 1949   DOI
8 Shin KS: Correction of cleft lip nose deformity. J Korean Soc Plast Reconstr Surg 11: 245, 1984
9 Kohout MP, Aljaro LM, Farkas LG, Mulliken JB: Photogrammetric comparison of two methods for synchronous repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg 102: 1339, 1998   DOI
10 Skoog T: Repair of the cleft maxilla using periosteal flap. Panminerva Med 9: 405, 1967
11 Van der Wal KG, van der Meulen BD, van der Biezen JJ, Mulder JW: Bone grafting the piriform aperture deformity in isolated cleft lip patients: indication, technique, and results. J Oral Maxillofac Surg 55: 1089, 1997   DOI   ScienceOn
12 Sclafani AP, Romo T 3rd, Silver L: Clinical and histologic behavior of exposed porous high-density polyethylene implants. Plast Reconstr Surg 99: 41, 1997   DOI
13 Converse JM, Hogan VM, Barton FE: Secondary deformities of unilateral cleft lip and nose, and cleft palate. In WC Grabb, Rosenstein SE, Bzoch KR.(eds): Cleft Lip and Palate. Boston, Little Brown & Co., 1971, p 2165
14 Cosman B, Crikelair GF: The reconstruction of the unilateral cleft lip nasal deformity. Cleft Palate J 31: 95, 1965
15 Finn RA, Bell WH, Brammer JA: Interpositional "grafting" with autogenous bone and coralline hydroxyapatite. J Maxillofac Surg 8: 217, 1980   DOI   ScienceOn