An anatomical composite nasal lining subunit technique in primary cleft nose correction.

Current primary cleft nose correction techniques are associated with a significant rate of long term alar collapse. The nasal lining on the cleft side has been observed to be distorted and deficient. Nasal endoscopy was used to map the two dimensional topography of the anterior nasal airway lining in a normal and patient with unilateral cleft lip. The vestibular nasal subunit was noted to have a triple structural overlap (Lateral crus, valve and vestibule units). A nasal lining subunit based surgical strategy was designed, based on the subunit principle. The lateral crural tethering was released and differential repositioning of the cartilage/lining complex performed. The difference in domal height between the cleft and non-cleft sides was translated into a superior and medial advancement of the cartilage/lining composite subunit. The valve sub-unit defect was resurfaced with a vermilion full thickness graft, taken at the time of primary cleft lip repair. Primary septal relocation was performed and no percutaneous cartilage sutures were done. Pre and post-operative anthropometry measurements were obtained, and repeated at follow up. Complete nasal correction was seen in the unilateral cleft lip patient and was noted to be stable at 1 year follow-up. A novel nasal cartilage/lining subunit topographical map is proposed and forms the basis for a surgical strategy addressing comprehensive correction of the unilateral cleft nasal deformity.