A MODIFICATION OF THE PRIMARY NASAL CORRECTION IN THE ROTATION-ADVANCEMENT UNILATERAL CLEFT-LIP REPAIR

Primary correction of the unilateral cleft lip nasal deformity remains a challenge to the cleft surgeon. We wish to present a method of prim ary nasal correction utilizing presurgical orthopedics with the Latham dentomaxillary advancement appliance, concomitant rotation-advancemen t cleft lip repair, gingivoperiosteoplasty, and immediate correction o f the nasal cartilage distortion with an ''open technique'' utilizing the rotation-advancement incisions. Direct elevation and suture fixati on of the cleft side alar cartilage is performed as well as recreation of the normal upper lateral/lower lateral cartilage relationship, rep air of nasal web, and release of the vestibular lining utilizing an L- flap pedicled to the alar base. Details of the operative technique, ob servations of unilateral cleft nasal anatomy as visualized with the '' open technique,'' and preliminary results are illustrated in patients followed as long as 5 years.