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A Subcutaneous Alar Base (SCAB) Flap to Restore Symmetry of the Ala in Primary Cleft-Lip Nose Repair

Sherif, Mahmoud Magdi MD, PhD

doi: 10.1097/SAP.0b013e3182858717
Head and Neck Surgery

Primary surgical correction of cleft-lip nose deformity is now well accepted. Despite various surgical techniques proposed, perfect nasal symmetry has not been persistently attained. The main reason is that the maxillary deficiency is frequently overlooked.

This paper presents 62 cases of unilateral cleft lip repaired over the last 20 years by using the author’s modification of the Millard primary lip nose repair. Each of these patients had a minimum follow-up of 1 year (range 1–12 years).

The technique consists of raising a small subcutaneous alar base flap (SCAB) from the nasolabial region. The flap is turned over like a book page to add bulk to the deficient maxilla and to elevate the depressed ala. It also controls alar rotation and permits its permanent fixation to the anterior nasal spine.

The results show that this modification has improved the alar contour and symmetry in patients undergoing primary cleft-lip nasal repair. There was minimal increase in the operating time and the final scar is similar to the original Millard technique.

From the Ain Shams University, Cairo, Egypt.

Received February 4, 2012, and accepted for publication, after revision, December 31, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: M. Magdi Sherif, MD, PhD, Ain Shams University, 17 Ibn Sina Street, Flat 41, Heliopolis, Cairo 11361, Egypt. E-mail:

© 2014 by Lippincott Williams & Wilkins