Modified forked flap for controlling columella length in cleft lip open rhinoplasty

Background & purpose: Suturing the columellar flap after open rhinoplasty often reduces the tip projection gained, especially in patients with cleft lip deformity, in whom the columella is usually short and inelastic. A modification of the classical forked flap is proposed for controlling the tension created by the columellar suture. Patients: Five patients aged from 17 to 35 years underwent surgery in the previous 2 years using the described techniques. Methods: The columella incision followed the classic tepee shape, although the inverted V was extremely narrow and long, with its arms extending beyond the columellar rims, stopping at the base of the vestibule, then making acute angles and heading vertically towards the nostril tip, and continuing into the nostrils as normal marginal incisions. Consequently, a complete "W" was used, in which the lateral angles and arms lay in the nostrils, while the central inverted V was in the columella. The rhinoplasty was performed as planned and a triple "V-Y" suture was made. Results: The technique provided real lengthening of the columella or, at least, it closed the columellar incision without tension, thereby preserving the tip projection. Conclusions: In open rhinoplasty on patients with cleft lip involvement a triple V-Y columellar suture preserves the surgically obtained columella length. (c) 2008 European Association for Cranio-Maxillofacial Surgery.