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Department of Plastic and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, 15, Khordad Medical Centre, Aban Street, Karim Khan Blvd., Tehran, Iran
Department of Plastic and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, 15, Khordad Medical Centre, Aban Street, Karim Khan Blvd., Tehran, Iran
Satisfactory reconstruction of the columella area is always challenging. An 8-year-old girl underwent columellar reconstruction 7 years after bilateral cleft lip surgery using a temporo-parieto-auricular flap. This method was found to be useful for columellar reconstruction with good colour and aesthetic result.
Columella reconstruction, especially in bilateral cleft lip, is a challenge. Variations of columella length in all types of bilateral cleft lip have led to the development of different corrective surgical procedures. Columella defects can also result from surgical resection of tumour tissue or traumatic injuries to the lower nose. In these cases perioral tissue cannot be used for columella reconstruction.
A case of reconstruction of a short and small columella using a Washio flap is presented in this article.
1. Case report
An 8-year-old girl with small and short columella was referred for nasal reconstruction (Fig. 1(A) and (B)) . She had been operated on for the correction of bilateral cleft lip 7 years prior to the referral. Her columella was short and retracted. Several scars in the upper lip region due to previous surgery were visible.
Fig. 1(A and B) Columellar defect, preoperative. (C) Immediate postoperative, flap still attached. (D and E) Two years postop, good accommodation of transferred tissue and satisfactory nasolabial relationship.
Under general anaesthesia, the columella recipient area and right temporo-parieto-occipital area was prepared. Contracted and tight scar of the columella were excised and the retracted part of the lip and nose was released by sharp dissection. Soft triangle scar was trimmed to normal nasal mucosa. Retroauricular non-hairy skin was prepared for transferring to the recipient area, according to conventional Washio flap. The flap was then elevated, and the retroauricular skin of the distal end of the flap was sutured to the prepared recipient area (Fig. 1(C)) for 3 weeks. The proximal end of the flap was then cut, and the unused portion was returned to the bare donor area. The remaining segment of the flap was sutured to the recipient site. The flap colour in the recipient area was good, and in a few weeks good colour adaptation with nasal skin occurred. Fig. 1(D) and (E) shows the aesthetic result of columella reconstruction 2 years after surgery.
3. Discussion
One of the main problems in reconstruction of bilateral cleft lip is the small prolabium and prominent premaxilla.
In these cases the prolabium itself may not be of adequate length and width for columella reconstruction. Also the same situation may be encountered in cases of trauma, tumour, burns, and necrotising infections.
Different techniques have been used for reconstruction of the columella employing perioral tissues such as prolabium V-Y plasty
Although nasolabial and frontal flaps do provide sufficient tissue for repair, they leave visible facial scars.
For several years the Washio flap has been used for the reconstruction of lateral nasal and alar defects. This flap produces good skin colour match in the facial region. In this presentation we have shown that this flap is a good choice for columella reconstruction, due to its colour match and reliability. In addition due to the sufficient width of the flap, it can be used for reconstruction of the nasal dorsum and columella too.
References
Milard Jr, D.R.
Closure of bilateral cleft lip and elongation of columella by two operations in infancy.
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