Evaluation of Modified Unilateral Nasoplasty in Patient with Post Operation of Unilateral Labioplasty at Malahayati Hospital Banda Aceh: Cohort Study from 2017 until 2019

Devyana Enggar Taslima, Muhammad Taufika , Muhammad Jailania* , Syamsul Rizala , Mirnasari Amirsyaha aClinical Research Unit Cleft Lip and Palate Center Aceh, Banda Aceh, Indonesia bPlastic Reconstructive and Aesthetic Surgery Division Faculty of Medicine Universitas Syiah Kuala Banda Aceh, Indonesia *Corresponding author: Muhammad Jailani; Plastic Reconstructive and Aesthetic Surgery Division Faculty of Medicine Universitas Syiah Kuala Banda Aceh, Indonesia; Email: jailani@unsyiah.co.id

INTRODUCTION air and Brown first described the cleft nose in 1931, critically identifying the nuances of the pathology.(4) The nose and the lips develop from derivatives of these prominences as follows: frontonasal prominence, lateral nasal process, medial nasal process, maxillary prominences, mandibular prominences, mesenchyme in the facial prominences. (5) The most complicated morphogenic movement occurs between the fourth and eight weeks of embryogenesis. (6) Nasal deformity associated with cleft lip has been viewed as one of the most challenging reconstructive problems in rhinoplasty. The complexity of cleft lip rhinoplasty is demonstrated by the abundance of technique that is available for its correction.(7) The common clinical features associated with cleft lip nasal deformity are its lack of symmetry, alar collapse on the affected side, short nasal length, loss of tip definition, obtuse nasal labial angle, and altered columella show among others.  (9)(10) During rhinoplasty surgery, we make an incision design at the cleft area and the normal side as the rule. Release all the nose cartilage such as greater alar cartilage, lateral nasal cartilage, lesser alar cartilage and septum cartilage from the skin on the nose cleft side area. After we separate the skin and the cartilage, the excess skin at this part is removed and the cartilage fixed on the upper side of the nostril area once believed to be nearing the normal point.    7-12 After we separate the skin and the cartilage, the excess skin at this part is removed to get the ideal shape of the nostril which is then sewn to the upper nostril area.
On the columella septum section, fixation of the inner nasal area between the cleft and the non-cleft area (transnasal sutures) (Fig. 13) to create the nasal dome for better symmetry and projection (raise the cartilage / repositioning the cartilage) to a rather normal position.(11) It sewn using absorable thread Proline 6-0 and eventually make the septum cartilage stand straight.

Fig. 13
Transnasal sutures to create the nasal dome for better symmetry and projection, and also make the septum cartilage stand straight to support nasal dome and nasal tip at the center.

METHOD
We conducted a retroperspective study involving 139 patients who is done the rhinoplasty unilateral operation at Malahayati Hospital from January 2017 to November 2019. Demographic information was recorded such as ratio between preoperation and post -operation, gender and age.   From 2017 to 2019, out 172 patients who registered for unilateral rhinoplasty procedure, 81% were followed up. The gender ratio is 0.38 to 0.61 with female predominates. The age group incidence highest for age 1 -7 years old with 71% from the total samples. Post procedural observations showed slight improvement at normal side 0.060 : 0.66 and 0.26 : 0.58 on the cleft side.

DISCUSSION
A deformed nose that results from unilateral cleft of the lip and palate is likened to a tent whose one side depressed. This modified technique that introduced by Dr. Muhammad Jailani, SpBP-RE, even without doing the usual technique, the surgical outcome still come out good. This technique can be applied to unilateral cleft nose post -labioplasty procedure. .Improvement in procedure's duration and better positioning of both nasal tip and nostril (pre -rhinoplasty and postrhinoplasty ratio is ±0.26 : ±0.58) and expected improvements in terms of aesthetic and functions were observed but further documentations still needed.