Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique

Background: Improving growth-related nasal stability is a critical goal of primary cleft lip repair. The purpose of this study was to evaluate the growth-related stability of the nose after unilateral complete cleft lip (UCCL) repair with standard rotation-advancement (RA) and modified rotation-advancement (MRA) techniques. Material and method: In this retrospective study, 52 non-syndromic (UCCL) patients were treated with a MRA technique, where a C-flap and a superiorly based advanced flap were used to lengthen and support the columella and nasal sill, and 48 patients were treated with a standard RA technique. Photos were taken before surgery (T1), immediately after surgery (T2), 1 year after surgery (T3), and 5 years after surgery (T4). Cleft width ratio, maxillary discrepancy, ala collapse, ala base position, columellar angle and height, nostril height, and width were all measured. The t-test, repeated-measure analysis of variance (ANOVA), stepwise multiple regression, inter-class correlation coefficient, and ANOVA with Bonferroni corrections were conducted. Results: MRA improved columellar height significantly at T3 and T4. Growth-related columellar height stability at T2-T4 was significantly better in the MRA group (P = 0.08) than in the standard RA group (P = 0.007). Nasal width was a moderate predictor of post-operative outcome, and maxillary discrepancy and ala collapse were moderate predictors of growth-related nostril height changes. Conclusion: Both groups demonstrated the same measurement stability at 1 and 5 years, except for the columellar height in the standard RA group, which deteriorated and then improved over time due to unknown reasons. Furthermore, the MRA group had better columellar height symmetry than the standard RA group at 1 and 5 years after surgery. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.