Evaluation of the Results of Simultaneous Open Rhinoplasty and Abbe Flap for the Reconstruction of the Secondary Bilateral Cleft and Nasal Deformity
Goals/Purpose: We aimed to evaluate of the results of simultaneous open rhinoplasty and Abbe flap for the reconstruction of the secondary bilateral cleft and nasal deformity.
Methods/Technique: A total of 16 patients with the bilateral cleft lip nasal deformity received Abbe flap and simultaneous open rhinoplasty during the period of 2004-2010. None of the patients had prior orthognathic operations. Mean patient age at the time of the operation was 21 years, and ranged from 17 to 25 years. The average follow-up period was 2.4 years. Part of the prolabial skin was preserved and marked as an extended columellar flap. It was prepared to use for columellar elongation during open rhinoplasty. Remaining defect on the upper lip was planned to reconstruct with Abbe flap. The Abbe flap was designed 12 to 14mm in length and 10 to 12mm in width and contained full-thickness tissue from the central lower lip, with a slightly wider U shape caudal end (Figure1).
Figure 1. Preoperative planning.
First step of the surgery was the elevation of extended columellar flap with rim incision. Than regular open rhinoplasty was performed and the nasal tip reconstruction was performed with cartilage graft. The skin defect of the elongated columella was closed with extended columella flap. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. The Abbe flap was then transposed cephalad, insetting into the median defect and sutured in layers. Doyle splints were used for nasal packing. The pedicle was cut after 14-17 days later.
Preoperative and postoperative (6th months) photographs which had been taken laterally were evaluated by using software (Adobe Photoshop® CS4). After the conversion of the lateral images to the grayscale pattern, nose, lips and ears boundaries' were marked (path drawing), (Figure 2). Images were standardized on the basis of ear size (Figure 3).
Figure 2. Path drawing. After the conversion of the lateral images to the grayscale pattern, nose, lips and ears boundaries' were marked on the preoperative and postoperative images.
Figure 3. Preoperative and postoperative images were standardized on the basis of ear size.
Length of the columella (from the columellar base to the the most inferior line of the infralobular triangle) and the distance of the most anterior point of the upper lip to the vertical plane tangent to the most anterior point of the lower lip were measured in pixels on standartized preoperative and postoperative images (Figure 4), (1). The differences between the preoperative and postoperative images were calculated and compared as a percentage (%).
Figure 4. The measurement of the columella and the upper lip advancement.
Results/Complications: There was no flap loss and associated problems. In terms of airway obstruction due to combined surgery, no problem was encountered. In 5 patients, minor revision was performed on upper lip. In the average of %55.1 increases was determined between the preoperative and postoperative columellar lengths. The most anterior point of the upper lip was displaced to the anterior on average of %67.11. Simultaneous surgery corrected the both nasal and lip deformity. The facial profile of the patient was improved as well (Figure 5).
Figure 5. The facial profile of the patient was improved (Preoperative and postoperative 6th months)
Conclusion: Simultaneous open rhinoplasty and Abbe flap is an effective reconstructive method for the correction of the bilateral cleft lip and nasal deformity. Even though no patient had prior orthognathic surgery facial profile of the patient was improved following this procedure. The results of the treatment modality were successfully evaluated by newly developed software based method.
References
1- Rollin K. Daniel. Mastering Rhinoplasty, 2nd Edition, Springer, page 158-159.