Functional Primary Surgery in Unilateral Complete Cleft Lip

편측구순열 1차수술

The alar base on the cleft side in unilateral complete cleft lip, alveolus and palate is markedly displaced laterally, caudally and dorsally, By incising the pyriform margin from the cleft margin of the alveolar process, including mucosa of the anterior part of the inferior turbinate, to the upper end of the postnasal vestibular fold, the alar base is released from the maxilla, A physiological correction of nasal deformity can be accomplished by careful reconstruction of nasolabial muscle integrity, functional repair of the orbicular muscle, raising and rotating the displaced alar cartilage, and finally by lining the lateral nasal vestibule, The inferior maxillary head of the nasal muscle complex is identified as the deeper muscle just below the web of the nostril, The muscle is repositioned inframedially, so that it is sutured to the periosteum that overlies the facial aspect of the premaxilla in the region of the developing lateral incisor tooth, And then, the deep superior part of the orbicular muscle is sutured to the periosteum and the fibrous tissue at the base of the septum, just in front of the anterior nasal spine, The nasal floor is surgically created by insertions of the nasal muscle complex in deep plane and of the orbicular muscle in superficial one, The upper part of the lateral nasal vestibular defect is sutured by shifting the alar flap cephalically, The middle and lower parts of this defect are closed by use of cleft margin flaps of the philtral and lateral segments, respectively, Authors stress the importance of nasal floor reconstruction at primary surgery and report the technique and postoperative results.