Assessing morphometric changes when performing a staged Abbe flap and rhinoplasty for the management of bilateral cleft lip nasolabial deformity.
Anamika Veeramani, Karl Bruckman, MD, DDS, Derek Steinbacher, MD, DMD.
Yale University, New Haven, CT, USA.
Background: The mature bilateral cleft nasolabial deformity is characterized by prolabial and vermillion deficiency, short philtral distance, and a broad depressed nasal tip with diminished columellar length. Many strategies have been employed to correct these remaining stigmata, each with varying degrees of success. The purpose of this paper is to describe one such strategy – a sequenced approach staging an Abbe flap and rhinoplasty, and to quantitatively assess the morphometric changes and effectiveness of this technique.
Methods: Patients treated using the staged Abbe-rhinoplasty, with at least 1-year follow-up, were retrospectively included. Demographics, operative details, and outcomes were assessed. 3D photogrammetric images were captured and morphometrically examined at two time points – preoperative (T0) and 1 year postoperative (T1), using VECTRA™ software. Statistical analysis included a Student’s t-test (with p < 0.05). Morphometric measurements included philtrum length, upper lip length, vermilion of the upper lip, columellar length, nostril height, distance from the tip to subnasale, and tip projection – all measured linearly.
Results: A total of 8 patients met the above inclusion criteria - 2 men, 6 women (with mean age of 18.6 years), each undergoing 2 surgeries in the staged procedure, for a total of 16 surgeries. When comparing pre- and post-operative morphology, all patients demonstrated an increase in philtral, columellar, and upper lip lengths (preoperative and postoperative means of 9.15 and 12.37mm, 8.86 and 10.29mm, 14.87 and 18.62mm, respectively; p < 0.05). Additionally, the postoperative results, when compared to Farkas norms were statistically similar.
Conclusions: A staged Abbe-rhinoplasty is a powerful technique to address the nasolabial deformities in the end-stage bilateral cleft patient. Morphometric comparison shows a qualitative and quantitative improvement of all variables, specifically nasal tip projection and increased nostril length. Thus, the staged Abbe-rhinoplasty technique should be considered when treating such patients.
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