Repairing Nasal Floor Depression Secondary To Unilateral Cleft Lip Surgery With Autologous Chin Bone Graft

Objective:To explore the effect of new surgical technique on repairingnasal floor depression after unilateral cleft lip surgery with autologous chinbone graft， to investigate the feasibility of simultaneous correction of nasalfloor depression after cleft lip surgery and alveolar cleft at same time, and toevaluate preliminary clinical effect.Methods: Eight patients with nasal floor deformity after unilateral cleftlip surgery admitted to our hospital from January2005to December2013underwent labial bone graft from the mandibular symphysis to repair thedeformity; five of them with alveolar cleft received alveolar cleft surgery.Nasal floor height, nasal shape and functional changes were observedpreoperatively, intraoperatively and postoperatively. Of the8patients, therewere5males and3females, age ranged from9to21years, with a median ageof15years. After a sound preoperative examination, no surgicalcontraindications were detected for treatment. The patients had desirability forsurgery subjectively, and were able to understand the risks of surgery. Allsurgeries were performed under general anesthesia. For patients withoutalveolar cleft, transverse incision was performed at the maxillary vestibularsulcus to have the inferior border of piriform aperture with bone defectseparated and exposed. While for patients with alveolar cleft, incisions weremade along the border of the cleft, and then mucoperiosteal flaps on the nasalside, vestibular side as well as palatal side were sutured to form a completebone graft bed. Transverse incision was performed at mandibular vestibule toexpose bone of the mandibular symphysis; the area between the mandibularcanines were drilled and cuboid bone which was2.0cm×0.5~1cm in size andabout0.3~0.5cm in thickness was cut and grafted in recipient area at inferiorborder of piriform aperture; and cancellous bone on medullary cavity side of the plate was used to fill bone graft bed of alveolar cleft, so as to improvenasal floor height and continuity of inferior border of piriform aperture byvirtue of natural curvature and thickness of cortical bone. Titanium screwswere used to fix the grafted bone on its both sides. Then washed and tightlysutured to close the wound. Routine postoperative care included prophylacticuse of antibiotics, liquid diets were recommended for a week, and stitcheswere removed in7to10days. Anteroposterior and hypsokinesis images ofpatient were photographed preoperatively and postoperatively to be compared.The effect was evaluated comprehensively in terms of appearanceimprovement and functional recovery, and a long-term follow-up study wasmade. Following criterions were taken into consideration: the improvment ofnasal shape, adverse reactions and complications, situation of grafted bone,subjective visual effect, adjacent teeth damage, sealing of oronasal fistula,damage in motor or sensory nerve, recovery of both vocal and masticatoryfunctions.Results: Eight cases had successful surgeries without severeintraoperative complications. Seven cases obtained primary healing, while1female patient suffered from postoperative infection, and then receivedeffective antibiotic treatment; the graft was survival without rejection. After6to12months’ follow-up, there was significant improvement in the nasal floorheight on ipsilateral side with good appearance but without nerve damage oradjacent teeth damage, the donor area of the mandibular symphysis hadperfect quality of healing, no affected on movement of opening and closingmouth and the result was satisfactory. Five cases received alveolar cleftsurgery had complete alveolar shape and had alveolar height recovered tovarying degrees and oronasal fistula well fixed and closed. Besides, vocal andmasticatory functions were improved significantly.Conclusion: Autologous bone graft from the mandibular symphysis canprovide sufficient bone to meet the requirement of both repairing of nasal floordepression and alveolar cleft surgery in most instances. It is reliable and safeto repair nasal floor depression after unilateral cleft lip surgery by autologous bone graft from the mandibular symphysis, and concurrent alveolar cleftsurgery can be performed, which has a good effect and is worthy of furtherapplication in clinical practice.