A new modified forked flap and a reverse V shaped flap for secondary correction of bilateral cleft lip nasal deformities

Background The columella, nasal tip, lip relationship in the bilateral cleft lip nasal deformity remains a great challenge for plastic surgeon. An esthetically satisfying result is difficult to obtain. A subset of patients with bilateral cleft lip nasal deformity still require columellar lengthening and nasal correction and philtrial construction. This study aimed to provide a new method based on the forked flap to improve the final appearance of these patients. Methods A technique to correct this deformity is described. This consists of （1） a newly modified forked flap including the orbicularis oris muscle and nasalis muscle along the whole flap for columellar lengthening, （2） a reverse V shaped flap from the lower portion of the columella and the prolabium for normal size phitrum construction, （3） inserting the vermilion portion of the forked flap and advancing the nasal floor medially and anteriorly to lengthen and maintain the nasal septum side of the columella for proper tip positioning, （4） open rhinoplasty, allowing definitive repositioning of the lower lateral cartilages, （5） reconstruction of the orbicularis orismuscle as required, and （6） the flaring nostril floor advancing medially and constructing the sill. Results This technique was applied to 15 cases of secondary bilateral cleft lip nasal deformity. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the height of the prolabium was added with normal size philtrial dimensions. Conclusions This method makes maximum use of the tissue containing the scar in the lip and limits tissues in the lower portion of the columella and the prolabium for adequate columella elongation and reconstruction with normal size philtrial dimensions. It is a very reasonable and useful method in correction of secondary bilateral cleft lip nasal deformities.