NASAL SILL AUGMENTATION IN ADULT INCOMPLETE CLEFT-LIP NOSE DEFORMITY USING SUPERIORLY BASED TURN-OVER ORBICULARIS ORIS MUSCLE FLAP - AN ANATOMIC APPROACH

Adult incomplete cleft lip nose deformity is not uncommon in India. Po verty, ignorance, and parental neglect account for its late presentati on. Besides the classical features of cleft lip nose deformity, the co nstant findings observed in this patient population have been a widene d and depressed nasal sill. This is attributable to the sparse, hypopl astic, and abnormally orientated orbicularis oris muscle in the region of the sill. Failure to restore the nasal sill symmetry by suitably a ugmenting the sill frequently leads to unsatisfactory and asymmetric r esults. However, in the literature, satisfactory restoration of the na sal sill has not been given the importance it deserves while performin g cleft lip rhinoplasty. We present a method of augmenting the depress ed nasal sill in cases of adult incomplete nose deformity using a supe riorly based orbicularis oris muscle flap, which is harvested from the soft tissues between the apex of the cleft and the nostril sill. Foll owing deepithelialization of the overlying skin, the exposed muscle is raised as a superiorly based flap after dissecting it from the underl ying mucosa. It is folded, turned ol er, and tucked into the nasal sil l base and anchored to the anterior nasal spine to give the desired au gmentation. Satisfactory results have been obtained in 18 cases of nas al deformity associated with incomplete cleft lip. In our opinion, thi s technique offers a simple and effective method of augmenting the dep ressed sill by utilizing locally available tissues and without the nee d for procuring autologous tissue from distant sites.