The purpose of this study was to audit the process and outcome in terms of
nasal-tip symmetry of the first 20 patients with unilateral complete cleft
lip and palate treated by the Pigott alar leapfrog primary nasal correction
in the early 1970s and followed for 20 years. Symmetry was assessed using
the Coghlan computer-based analysis of frontal and basal views to determine
the stability of the correction. The Abyholm technique of alveolar bone gr
afting was performed in 12 of the 20 patients. Various other secondary proc
edures have been performed on the nose tip and septum to improve the airway
or appearance. Photographs were taken within one year of ages 5, 10, 15 an
d 20 years, and the lower border of the nose, the alar domes and the nostri
ls were assessed. To assess the overall change from 5 years to 20 years, bo
th views were available for 17 patients. No significant change was found in
the lower border or nostril symmetry, but significant deterioration at the
P < 0.01 level was found on the basal view. We assessed the 10, 15 and 20
year views of all 12 patients who had undergone alveolar bone grafting to d
etermine early and late changes. No significant benefit was found from alve
olar bone grafting or minor secondary procedures for appearance. Consequent
ly, our criteria for undertaking minor adjustments to improve appearance ha
ve become more stringent. We consider that objective reporting of appearanc
e should become essential in peer-reviewed journals. (C) 2001 The British A
ssociation of Plastic Surgeons.