Correction of Post-Cleft Lip Nostril Floor Stenosis: Para-Alar Flap Combined With Lip Revision

Abstract

Post-cheiloplasty nostril floor stenosis is a scarcely reported secondary deformity. The aim of the current study was to assess the outcome of para-alar flap for management of nostril floor stenosis post-unilateral cleft lip repair. This is a retrospective case series study reviewing consecutive patients presenting with nostril floor stenosis following repair of unilateral cleft lip who were managed by the inferiorly based para-alar flap and lip revision. Differential nostril width was measured preoperative, immediate, and late postoperative. We reported 8 patients (3 boys and 5 girls) with an average age of 9.8 years (range: 4.5-19). Satisfactory results with good nostril symmetry measures were achieved, and no restenosis has been observed during the follow-up periods. The donor site scars were negligible. There was no reported partial or total flap loss. Para-alar flap was found to be an effective reconstructive option for patients with nostril floor stenosis post-unilateral cleft lip repair and can be combined safely with cleft lip revision.

Inferiorly Based Alar Groove Flap for Correction of Alar Base Malposition and Nasal Stenosis

“…A more recent study describes correction of alar stenosis with a para-alar flap. 5 The authors also employ an inferiorly based flap to increase the size of the nasal floor. However, their flap design incorporates a lip revision into the repair.…”

“…Literature on correction of stenotic nares is limited, 4,5 but includes some of the following methods: W-and Z-plasties, full or partial thickness skin grafts, chondrocutaneous grafts, and nasolabial flaps. [6][7][8] In one case series, Constantian uses a crescent-shaped local flap adjacent to the alar base to correct alar base malposition.…”

“…However, repositioning a medially displaced alar base is less commonly described. 4,5 This case series presents patients with alar base malposition and ENV collapse resulting in significant airway obstruction. To address this complex nasal deformity, our surgical team designed an inferiorly based flap from the alar groove to facilitate lateral repositioning of the alar base and alleviate nasal stenosis.…”