Table 2 The data of articles addressing the sill graft/augmentation in terms of the technique, approaches, clinical results, and complications. UCL, unilateral cleft lip; BCC, basal cell carcinoma; AB, alar base; NCR, no complications reported
Deformity | Technique | N | Approach | Follow-up | Clinical outcomes | Complications | Ref. |
|---|---|---|---|---|---|---|---|
UCL | Flap repositioning following dissecting depressor septi and the medial orbicularis oris muscles | 378 | AB (along the scar line) | 12 months | Stable and natural form of the nostrils and nasal sill | NCR | [13] |
UCL | Use of Millard method for correction of the upper part of the lip Elevation of superiorly based scar flap Creation of soft tissue pocket in the nostril floor Folding and insertion of scar flap into the pocket Flap securing with a pull-out stich | 16 | AB (along the scar line) | Up to 4 years | Acceptable esthetic outcomes | Long lip Drooping of the cleft side Pyriform gap | [3] |
UCL | Double Composite Tissue Z-plasty using ilium, rib or costicartilage graft if necessary | 68 | AB (along the scar line) | 14.6 months | Symmetric width of the nostrils and nasal sill and correction of septum and columella deviation | 2 graft deviation, 4 impaired ventilation, 1 decreased nostril size No complications such as bleeding, infection, flap necrosis, and sensory dysfunction | [10] |
UCL | Triangular flap with pedicle on the nasal base transferred medially to reconstruct the nostril sill | 9 | AB (along the scar line) | No follow-up was reported | Elevation of the sill area was reported, satisfactory results by the patients. | NCR | [14] |
UCL | Elevation and subsequent overlapping of medial and lateral orbicularis oris muscle flaps through an intraoral incision without using filling materials; a tight, large-bite suturing of the muscle in the alar base to correct the sill depression | 60 | AB (along the scar line) | 20 months (Mean) | Effective nostril sill Augmenting without graft, minimal scarring | NCR | [15] |
UCL | Upper triangular flap Reestablishing of the sillo–columellar distance muscle layers approximation | 250 | AB (along the scar line) | 2 years for 40% of patients | Straight philtral column scar parallel to the noncleft side to hide the surgical scars on the medial aspect of the nostril and in the lip-columellar crease | NCR | [16] |
UCL | Muscle Tension Line Group Theory (first and second axillary tension line group) by operation in medial and lateral orbicularis oris muscle. | 263 | AB (along the scar line) | 18 months for 212 patients | In nearly half of the patient’s nasal sill was similar to normal anatomical sill, 17 patients do not have any improvement in the nasal sill appearance. | NCR | [17] |
Nose deformity in Incomplete cleft lip | Superiorly based orbicularis oris muscle flap from the soft tissue between the apex of the cleft and the nostril sill anchored to the anterior nasal spine. | 18 | AB (along the scar line) | 18–32 months | Acceptable esthetic result | NCR | [18] |
Unilateral cleft lip and palate | Alveolar bone grafting with iliac bone with 2.39 cm2 volume with a tension free suture in the flaps. | 18 | AB (along the scar line) | 16.6 months | Nostril sill elevated significantly on both basal and lateral views. | No major complications (infection, graft failure, wound dehiscence or persistence of an oronasal fistula) | [19] |
UCL, trauma, malignancies, assymetries | Composite earlobe grafts with sandwiched cartilage grafts, adjuvant hyperbaric oxygen therapy | 5 | AB (along the scar line) | Not mentioned | Restored nostril symmetry Increased size of nostril opening Improved appearance of deformed nasal ala | Partial epidermolysis of the graft (N=1) Patient dissatisfaction (N=1) | [20] |
Secondary cleft lip nasal deformity | Composite chondrocutaneous grafts; composite auricular conchal cartilage graft was harvested in an elliptical shape with 1 * 1 cm of skin island and 2 × 2.5 cm of cartilage in the base of the graft. | 12 | Along the scar line in cleft patient Through the involvement area in BCC patients Classic rhinoplasty approach for other patients | 6 months to 2 years | Satisfaction of patients in all cases, minimal morbidity in donor site, not specific data about the result of the sill area | Composite graft Protrusion (N=1). | [21] |
Primary correction of nasal deformity in unilateral incomplete cleft lip, A comparative study between three techniques | 21 | Closed rhinoplasty Cartilage dissection and repositioning through lip incisions | 5 years | Improvement in the nasal sill area was greater in group 2 and 3 compared to group 1; But the difference is not significant. | NCR | [22] | |
Incomplete UCL | Primary correction of nasal deformity in unilateral incomplete cleft lip, A comparative study between three techniques Performing 2 mucosal flaps in the upper lip margin, one flap pedicled around the alveolar cleft was horizontally rotated by 90° to approximate its mucosal surface to the oral side. The downside of another mucosal flap was sutured to the mucosal surface of flap D near the labiogingival groove, Orbicularis oris muscle was repositioned | 25 | A semi-open rhinoplasty technique Cartilage dissection through bilateral rim incisions | 5 years 3–6 months | Improvement in the nasal sill area was greater in group 2 and 3 compared to group 1, but the difference is not significant. Full nasal sills in all cases with patients’ satisfaction | NCR Shorter lip height on the cleft side with symmetrical lip length (N=4). Patient dissatisfaction about obvious scars on upper lips (N=3). | |
20 | A semi-open rhinoplasty technique Tajima incision on the cleft side and a Rim incision on the contralateral side | ||||||
Complete UCL | 45 | AB (along the scar line) | |||||
Complete UCL | Straight-Line Advanced Release Technique (StART) | 72 | AB (along the scar line) | 5 years | Symmetry between the sill areas, minimal scar in all cases | NCR | [9] |
Unilateral or bilateral complete cleft | Performing 2 medial and lateral upper lip mucosal flaps. The medial flap was sutured to the lateral nasal mucosa, forming the upper layer of the nasal floor. The lateral flap sutured to the tissue cuff of the gingivopalatal mucosa on the greater alveolar segment to form the lower layer of the nasal floor. The orbicularis oris muscle is repositioning. Nostril floor and nasal sill are formed by approximating the alar base flap and the septal flap. | 6 | AB (along the scar line) | 1 year | Symmetry of nostril shape and the fullness of the nostril sill | NCR | [24] |
BCC | Nasocheek flap and a septal cartilage graft Additional surgery for reconstructing the sill area after 3 months | 1 | Through the involvement area | Unknown duration | Columella with excellent contour, reconstructed sill area | No ischemia or congestion No donor site morbidity | [25] |
BCC | V-Y advancement flap Inferiorly based tunneled mesiolabial flap | 1 | Through the involvement area | 8 months | Preservation of the alar apical triangle Single-stage procedure Minimized eclabion formation | Central lip elevation | [26] |
BCC | A composite alar graft from the intact alar rim was placed in the opposite involved alar rim and a submental full-thickness skin graft was placed in the philtral area and nostril sill | 1 | Through the involvement area | 7 months | Good healing and reconstruction of the alar rim and philtrum, but not significant description regarding the sill area | NCR | [27] |
Binder's syndrome | Cartilage graft on the nostril sill area, dorsum, and around the pyriform aperture | 2 | Intraoral buccal sulcus incision between canines | 12 months | Improved nasal profile without scarring the columella | NCR | [28] |