TY - JOUR ID - TI - Primary Repair of Bilateral Complete Cleft Lip Nasal Deformity: Iraqi Experience تقويــم الانف الاولي للاطفال المصابين بشق الشفه الثنائي الكامل الولادي: خبره عراقيه AU - Ahmed A. M. Nawres PY - 2013 VL - 10 IS - 2 SP - 325 EP - 335 JO - Medical Journal of Babylon مجلة بابل الطبية SN - 1812156X 23126760 AB - Background: Simultaneous surgical correction of bilateral cleft lip nasal deformity is becoming more common. This is a major change from the conventional strategy of secondary nasal correction. Many studies had concluded that primary nasal repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. Aim: This study was conducted to document the pattern of primary nasal repair in bilateral complete cleft lip deformity and to evaluate the medium term outcome.Method: A total of 13 babies with bilateral complete nasolabial clefts underwent simultaneous nasal correction with their lip closure. Mean age was 4 months. The study was performed between March 2006 and April 2009. Alar cartilage manipulation using combined Mulliken - Cutting retrograde nasal approach was performed for all cases.Results: The average follow up periods were 3 years (ranging from 6 months – 6 years).The results were evaluated by comparing 3 nasal anthropometric measurements with those of normal, age-matched children pre and postoperatively at 3 months and then yearly till 3 years. The selected nasal anthropometric measurements were: nasal tip projection, columellar length, and interalar distance. Nasal tip projection and columellar length were normal or near normal in 5 babies but slightly shorter than in control group in 8 babies. The interalar distance was near normal in 9 babies but moderately wider than in control group in 4 babies. In one case, partial prolabial flap necrosis occurred and was revised successfully 6 months later. In another 2 cases, a hypertrophic scar formed on the upper lip which subsided after 6 months of scar management. Over all nasal tip shapes were improved in all cases with acceptable nostrils asymmetry.Conclusions: In cases where presurgical molding is not available, a combined Mulliken-Cutting approach is advisable for obtaining a reasonable primary nasal repair in bilateral complete cleft lip deformity. It is not advisable to create a philtral dimple with a deep dermal suture at the prolabial flap as it may compromise the blood supply. Alar dome suspension stitches might be useful for further improvement of alar dome projection. A long follow-up is needed to observe nasal growth over time and detail final outcomes.

ان عملية تقويم الانف الاولي للاطفال المصابين بشق الشفه الثنائي الكامل الولادي اصبح من العمليات الاكثر شيوعا عالميا وبهذا يمثل انعطافه كبيره عن الاستراتيجيه التقليديه المتمثله بتقويم الانف ثانويا حيث ان هنالك عدة دراسات توصلت الى ان تقويم الانف اوليا لهكذا اطفال لا يؤثر على نمو غضاريف الانف بل وحتى يساعد في ارجاع الغضاريف المشوهة الي مكانها الطبيعي محسنا بذلك نمط نموها.لقد بينت هذه الدراسه الطريقه المستخدمه في تقويم الانف الاولي لثلاثه عشر طفلا ، معدل اعمارهم اربعة شهور و أجريت خلال الفترة (اذار 2006 لغايه نيسان 2009)، وقد تم استعمال طريقه (موليكان/ كاتنج) لجميع الحالات وكان معدل فترة متابعه المرضى ثلاث سنوات وقد قيمت النتائج عن طريق مقارنه ثلاثة قياسات خاصه لمنطقه الانف مع عدد مماثل من الاطفال الغير مصابين من نفس الفئة العمريه وثبتت النتائج في الجدول المبين في الدراسة. ER -