الفهرس | Only 14 pages are availabe for public view |
Abstract The nasal deformity in unilateral cleft lip and palate is a social stigma, a burden to the patient and a challenge to the surgeon. A repaired cleft is revealed more by associated nasal deformity than by the lip repair line. If the orbicularis muscle only is repaired, the problems of a collapsed, imbalanced, and asymmetric nasolabial region after primary repair are challenging in correcting this deformity. Even after a good repair that results in an acceptable scar, animation will often indicate the presence of dysfunctional or misplaced muscular and cartilaginous tissues. Meaningful correction of cleft lip with or without palate can only be achieved when the surgeon is fully aware of normal and pathologic spatial relations and functions of the anatomic elements, particularly the muscular elements, which cause the deformity. In a complete cleft lip, the muscles of the nasal floor and the upper lip cannot bridge the gap of the cleft and they cannot unite with their muscular counterparts on the non cleft side. The muscular integrity of the region is considerably disrupted, which has a profound effect on the underlying skeleton. Many surgeons have identified the transverse nasal muscle as the most important physiologic element in the nasolabial ring. Together with the orbicularis muscle, they provide support for the corresponding half of the upper lip and, indirectly, the labial commissure. A controlled prospective study was conducted on patients with complete cleft lip with palate, aged between months and year. They were divided into two groups. The first group “control” underwent orbicularis muscle repair only. In the second group the nasalis muscle was repaired in addition to the orbicularis muscle and was further divided into subgroups. In the first subgroup the nasalis origin was repaired, and in the second subgroup the origin was repaired and the abnormal insertion was dissected. Patients were documented pre and postoperatively by Photography and evaluated subjectively and objectively by three different methods: cleft lip evaluation profile, nostril angles measurement, and direct anthropometry. Analyzing the results of this study makes it clear that nasalis muscle repair produce better outcome as regards nostril symmetry, symmetry of the tip of the nose, size and form of the ala, without hindering growth. When the nasalis muscle is not reconstructed the action of the muscles will be imperfect, resulting in dysfunctions that affect subsequent skeletal growth of the face. On the other hand, the primary nasalis muscle reconstruction restores anatomy, function, skeletal growth, and total facial aesthetics can be excellent. Thus the fundamental goal of the surgeon is to achieve anatomic muscular reconstruction, particularly with respect to anchorage of the complex nasolabial muscles especially nasalis of the cleft side to the nasal spine. Finally, Reconstruction of the nasalis muscle during repair of cleft lip helps to restore anatomical balance which reduce alar flaring, narrow the nostril, elevate the nasal sill, and improve contralateral caudal septal deviation. Therefore, nasalis muscle reconstruction should be considered in al cases of cleft lip and palate. Long term follow up is is highly recommended to predict the changes occurring after growth and maturation of the face. Deepening of the alar facial groove was a finding observed in groups with repaired nasalis muscle, and produced better aesthetic results. It should be further evaluated since it was not reflected before in the literature. |