Open versus closed rhinoplasty with primary cheiloplasty: a comparative study

Abstract

The repair of unilateral cleft lip nose deformity remains a challenging endeavor for reconstructive surgeons for many reasons, one of which is the timing of rhinoplasty, whether to be synchronous or staged with cleft lip repair and the technique for rhinoplasty. Many authors now favor primary rhinoplasty with the cleft lip repair. Various surgical techniques have been used, most commonly the closed and open rhinoplasty techniques. In this randomized controlled prospective study, we compare the closed rhinoplasty technique with open rhinoplasty during primary unilateral cleft lip repair. Thirty-six patients with unilateral complete cleft lip and nose deformity were selected. Out of this 19 patients were assigned randomly and operated with open rhinoplasty and 17 patients with closed rhinoplasty. The cleft lip repair was done using modified, Millard's rotation-advancement technique in both the groups. Follow-up assessment was done after 6 months. Quantitative and qualitative analysis were done. Statistical analysis of the data was done using SPSS 11.0. Post-operatively, the alar base width difference between the open and closed rhinoplasty techniques was statistically significant. There was no statistically significant difference in other parameters compared.

Keywords: Nose deformity; Open/closed rhinoplasty; Unilateral complete cleft lip.

Fig. 1

Mid-point of columella base to the midpoint of the ala base of both non-cleft and cleft side (alar base width)

Fig. 2

Height of nostril on cleft and non-cleft side

Fig. 3

Columella length on the cleft and non-cleft side

Fig. 4

Markings for modified Millard’s rotation-advancement technique

Fig. 5

Marking for closed rhinoplasty

Fig. 6

Marking for open rhinoplasty

Fig. 7

Dissection for closed rhinoplasty passed through the columella and the gingivolabial incision on the side of cleft

Fig. 8

Dissection for open rhinoplasty exposing the medial crus of the alar cartilage on the cleft and non cleft side and extending till the lateral angle of dome on the cleft side

Fig. 9

Medial alar cartilages were visualized, lifted upward, aligned symmetrically and sutured in place with three to four 5-0 proline sutures