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Positioning the Caudal Septum During Primary Repair of Unilateral Cleft Lip

Ridgway, Emily B. MD*; Andrews, Brian T. MD, MA*; LaBrie, Richard A. EdD; Padwa, Bonnie L. MD, DMD*; Mulliken, John B. MD*

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1219-1224
doi: 10.1097/SCS.0b013e31821c0ef1
Original Articles

Background: Since 1995, the senior surgeon has straightened the deviated anterocaudal septum in all infants undergoing primary repair of unilateral complete cleft lip/palate.

Methods: A retrospective assessment was done on 17 patients who did not have septal correction and 17 patients who did have septal correction at the time of nasolabial repair. Operative reports were reviewed, and secondary procedures on the nose were documented.

Posterior-anterior cephalograms were used to measure septal deviation from the midline, angle of septal deviation, and width of the inferior turbinate on the noncleft side. The angle subtended by the superior and inferior segments of the cartilaginous septum was measured at the point of maximal septal deviation.

Results: The uncorrected group had a mean maximal septal deviation from the midline of 5.8 mm compared with 4.1 mm in the corrected group (P < 0.01). The uncorrected group had a mean width of the contralateral inferior turbinate of 12.7 mm compared with 10.2 mm in the corrected group (P < 0.01). The uncorrected group had a mean subtended angle of 137.8 degrees compared with 147.9 degrees in the corrected group (P < 0.01).

Conclusions: Positioning the anterior caudal septum during primary repair of unilateral complete cleft lip results in less septal deviation and a smaller contralateral turbinate as documented by posteroanterior cephalometry in adolescence.

From the *Department of Plastic & Oral Surgery, Children's Hospital Boston; and †Division on Addictions, Harvard Medical School, Boston, Massachusetts.

Received August 19, 2010.

Accepted for publication November 14, 2010.

Address correspondence and reprint requests to John B. Mulliken, MD, Department of Plastic and Reconstructive Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02215; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD