The Efficacy of Cartilage Dissection & Repositioning in Primary Nasal Reconstruction in Complete Unilateral Cleft Lip Patients Received Nasoalveolar Molding

Background: Correction of the cleft lip nasal deformity is a challenge for all cleft surgeons. The introduction of presurgical nasoalveolar molding (NAM) by Grayson provided a technique that repositioned the maxillary halves and molded the nasal cartilages into a more normal state prior to surgery. This resulted in improved nasal shape and appearance immediately after lip repair. Aim and objectives: This study is to evaluate the efficacy of cartilage dissection and approximation by comparing two groups of unilateral complete cleft lip and palate patients (UCLP) that underwent NAM with or without lower lateral cartilage (LLC) dissection and approximation at the time of the initial lip repair Methods: A total of 140 UCLP Chinese infants had a lip and nose repair done by the senior author in the Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan, from February, 1998 to May, 2000. All patients received presurgical nasoalveolar molding (NAM) for a period of 2 to 3 months before surgery. The surgical results were analyzed using photographic records obtained at 5 years of age by a panel consisting of 10 cleft-professional personnel. Results: The reliability among the 10 evaluators showed good consistency (α value 0.9162 and 0.9260 in the two groups) among the evaluators. The mean score for the non dissected group is 64.14 +/- 10.63 while the mean score for the dissected group was 70.66 +/- 10.89. There is a significant difference between the two groups (paired t test, p＜0.05). Conclusions: NAM greatly improves the skeletal, cartilaginous and soft tissue discrepancy in UCLP patients, it does not solve all the problems. The addition of direct dissection of the LLC, removal of fibro-fatty tissue from between the medial crura and their approximation results in a more consistently improved symmetrical nasal configuration.