Augmentation of the nasal floor with Surgicel in primary lip repair: A prospective study showing no efficacy

The symmetry of the alar base and the nasal floor is very important in achi eving a satisfactory result in primary lip and nasal reconstruction during cleft lip repair. The skeletal base of the nasal pyramid is usually hypopla stic even in incomplete clefts. A periosteal pocket filled with Surgicel ca n facilitate blood clot formation and can theoretically stimulate bone form ation, thereby improving the asymmetry of the bone base. To test this hypot hesis, a prospective study was performed in 64 primary lip repairs by compa ring the effect of subperiosteal nasal floor augmentation with Surgicel, Fr om February 1989 to June 1993, 64 patients with incomplete cleft lips (excl uding occult cleft lip and complete clefts with Simonart's band) were opera ted by the same surgeon. The patients were divided randomly into two groups . One group had subperiosteal nasal floor augmentation with Surgicel and th e other group did not. The lip repair was a rotation-advancement cheiloplas ty with primary closed rhinoplasty of the tip and ala. In the first group, a subperiosteal pocket was created under the cleft alar base and the nasal floor, The pocket was filled with Surgicel up the point where the level of the alar base and the nasal floor was symmetrical with the noncleft side. T he control group underwent a similar procedure, less the creation of the su bperiosteal pocket and the use of Surgicel. All patients were followed for at least 3 years and their photographs were used to compare and analyze the results of their nasal correction, Critical attention was paid to the symm etry of their nasal floor and alar base. The results were evaluated by at l east two plastic surgeons for consistency. The data indicate that the contr ol group showed a higher number of subjects with asymmetry (10 of 32) compa red with the study group (8 of 32). However, there was no statistical signi ficance to the findings. Two patients in the study group who received Surgi cel developed hypertrophic lip scars. This study, although unable to determ ine statistically the contributory affect of Surgicel in primary nasal reco nstruction, does show a possible benefit from the use of osteogenic materia ls in the primary management of the deficient nasal floor. Hypertrophic sca rs developed by 2 patients in the study group may point to a possible soft- tissue reaction to the use of Surgicel in primary lip and nasal repair.