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Surgical Technique for Nasal Cleft Repair

Chapchay, Katya MD; Zaga, Jonathan MD; Billig, Allan MD; Adler, Neta MD; Margulis, Alexander MD

doi: 10.1097/SAP.0000000000001688
Head and Neck Surgery

Background Congenital nasal cleft is a very rare yet challenging deformity to reconstruct. Atypical craniofacial clefts that involve the nasal ala are designated as number 1 and number 2 under the Tessier classification system. These clefts typically present as notches in the medial one-third of either nasal ala and may be accompanied by a malpositioned cartilaginous framework. Nasal clefts are smaller and far less common than familiar clefts of the lip and palate, but they pose equally challenging reconstructive planning.

Methods Our described technique relies on usage of existing nasal tissue near the cleft. Local tissue rearrangement using a laterally based rotational alar flap, a medially based triangular flap, and a nasal wall advancement flap restores normal anatomy and provides an aesthetically pleasing result.

Results Five children with isolated nasal cleft were treated by the senior author (A.M.) between 2010 and 2017. All patients presented with clefts of the soft tissue with no underlying cartilaginous involvement. There were no postoperative complications. Excellent aesthetic outcome was achieved in all patients.

Conclusion Isolated nasal cleft can be properly corrected with the described procedure in a single stage and with optimal result.

From the Department of Plastic, Reconstructive, and Hand Surgery, Hadassah University Medical Center, Jerusalem, Israel.

Received April 8, 2018, and accepted for publication, after revision September 7, 2018.

Authorship declaration: All authors had a substantial intellectual contribution to the article. All authors are responsible for the content of the paper.

Conflicts of interest and sources of funding: none declared.

Reprints: Katya Chapchay, MD, Department of Plastic, Reconstructive and Hand Surgery, Hadassah University Medical Center, Ein Kerem, POB 12000, Jerusalem 91120, Israel. E-mail:

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