The Potter Technique for Cleft Lip Rhinoplasty

Abstract

Patients with unilateral cleftlip are, arguably,the most technically complex subgroup of rhinoplasty patients. Asymmetry of the three-dimensional nasal structure creates an obvious deformity that largely contributes to the cleftstigmata, particularly the nasal tip and alar base.' A IS-year-old girl presented with a history of leftsided, unilateral, complete cleft lip and palate, which had been repaired at an outside hospital during her infancy. She presented with complaints -of difficulty breathing from the left side of her nose, and she was very bothered by her nasal deformity. This patient's nasal asymmetry was identified on examination. The ala on the cleft side was flattened, with a subsequent hanging nostril; additionally, the dome was lower on the cleft side. The nasal tip and columella were pointing away from the cleft side, and the bony dorsum toward the cleft side. However, because of the alotomy performed at the time of her primary lip surgery, her alar base width was symmetric. As a result of her deformity, the soft-tissue triangles were extremely asymmetric, as were her nostril openings (figure 1). The patient's endonasal exam revealed that the "quadrangular cartilage was deviated toward the cleft side. Manual elevation of her ptotic left nasal ala caused a significant improvement in her breathing, and the standard Cottle maneuver did not prove beneficial. The preoperative surgical plan was carefully structured to address the patient's concern regarding her aesthetic nasal appearance; she was most bothered by the size discrepancy between the nostril openings and the hanging of the left nostril. The patient was marked for a standard inverted V incision of the mid-columellar skin, and the Tajima reverse-U incisionwas incorporated on the left side of the alar rim skin so as to create a symmetric, left-sided, soft-tissue triangle appearance (figure 2, A). The endonasal rhinoplasty was performed via a hemitransfixion incision, and all portions of the deviated quadrangular cartilage were removed, leaving a l.S-cm caudal and dorsal L-strut.