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 following unilateral complete cleft lip (UCCL) repair with standard and modified rotation-advancement techniques. Material and method In this retrospective study, 52 non-syndromic (UCCL) patients were treated with a modified rotation-advancement (MRA) technique where C-flap and superiorly based advanced flap were used to lengthen and support the columella and nasal sill, while 48 were treated with a standard rotation-advancement (RA) technique. Photos were taken preoperatively(T1), immediately (T2), 1 year (T3), and 5 years postoperatively (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 ANOVA analysis of variance, 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 RA group (P=0.007). Nasal width was a moderate predictor of postoperative outcome, and maxillary discrepancy and ala collapse were moderate predictors of growth-related nostril height changes. CONCLUSION Both groups demonstrated the same measurement stability between 1 and 5 years of age, except for the columella height in the RA group, which deteriorated and then improved over time for unknown reasons. Furthermore, the MRA group had better columella height symmetry than the RA group at 1 and 5 years postoperatively.