A modified V-Y chondromucosal composite flap for correction of secondary cleft nasal deformity: photogrammetric analysis of a case-control study.

BACKGROUND: Secondary cleft nasal deformity is a combination of the inherent cleft defects and the effects of operations to address the primary nasal deformity. The authors revisited a modified V-Y chondromucosal flap to restore symmetric nostril shape and balanced tip projection.

METHODS: A retrospective case-control study of the senior author's (J.A.T.) experience with secondary cleft tip rhinoplasty using the V-Y chondromucosal flap was conducted. Preoperative and postoperative anteroposterior and worm's-eye photographs were compared by means of photogrammetric analysis. Results were compared with those of controls who had not undergone surgery. Interrater reliability was assessed using the Pearson coefficient.

RESULTS: Seventeen cases and 24 controls were reviewed. Average age at repair was 9.3±3.6 years; average follow-up was 13 months. Interrater reliability was 0.98 overall. Photogrammetric analysis demonstrated postoperative increases in cleft-side columella length by 2.3 mm (p=0.0001) and nasal apex height by 1.3 mm (p=0.003); non-cleft-side measurements were statistically unchanged. Control measurements were similar across 1-year visit interval, and when compared with cases, patients undergoing tip rhinoplasty had significantly different cleft-side columella length postoperatively (increase of 2.31 mm versus 0.15 mm; p=0.0002) and nasal apex height (increase of 1.29 mm versus 0.17 mm; p=0.03). All other parameters remained comparable. No complications and no external nasal valve collapse were observed.

CONCLUSIONS: In select patients, use of a V-Y chondromucosal flap increased cleft-side nasal tip projection and columellar height, improving overall nasal tip appearance. Although absolute width of the cleft alar base is unchanged, the cleft-side nostril is qualitatively more symmetric postoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.