Three-Dimensional Efficacy Evaluation of Nasal Symmetry in Unilateral Cleft Lip Primary Repair: A Modified Rotation Advancement Technique

Objective: Objective assessment of the long-term postoperative outcomes of a modified rotation advancement combined with force balance orbicularis oris muscle reconstruction in patients with unilateral complete cleft lip and palate. Methods: Consecutive patients undergoing cleft lip primary repair were included (n=90). Three-dimensional images preoperatively (n=90), postoperatively (n=90), and at 5 years follow-up (n=57) were assessed and compared to age-matched controls. Results: In preoperative measurement, the subnasale and pronasale both exhibited a significant deviation. The cleft subalare was displaced both medially and posteriorly in comparison to the controls. Conversely, the noncleft subalare demonstrated a lateral drift. These observations collectively indicated an overall lateral drift of the nasal base towards the noncleft side. Surgical intervention successfully resulted in landmark positions that closely mirrored those of the controls. The symmetry of the nasal base was maintained at late follow-up within the cleft lip group. However, there was a significant downward and retrusive displacement of the cleft alar base, along with a notable lateral displacement of the subnasale and the noncleft alar base in both the cleft lip and alveolus/palate groups. Conclusion: The modified rotation advancement technique combined with force balance reconstruction of orbicularis oris results in promising symmetry of nasal base in patients with unilateral complete cleft lip. The alar base retrusion in patients with cleft lip and alveolus/palate is probably due to bony defect, which might be addressed by secondary alveolar bone grafting.