WOFAPS 2025 8th World Congress of Pediatric Surgery

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Oral Presentation - 76

Extended vestibular-alar incision improves surgical exposure and early nasal symmetry in primary rhinocheiloplasty: a two-centre randomized trial in infants with unilateral asymmetric cleft lip.

Abduvoris Abduvaliev
Tashkent Dental State Institute

Purpose.To determine if the extended vestibular-alar incision (EVI) facilitates better intraoperative exposure and early nasal symmetry in comparison to the standard Millard II incision in primary rhinocheiloplasty for asymmetric unilateral cleft lip.

Methods.This assessor-blinded, two-center randomized trial involved 46 infants (3-5 months) with complete unilateral asymmetric cleft lip who were allocated 1:1 to either EVI (n=23) or standard Millard II incision (Control, n=23). The EVI extends the lateral lip incision by 3 mm caudally along the alar base which results in a hinged skin-mucosal flap that can be used for direct columellar and alar cartilage repositioning.

Primary outcome: Operative Field Score (OFS; 1–5 scale; inter-rater ICC = 0.95)

Secondary outcomes: Nasal Symmetry Index (NSI; 0 = perfect symmetry, 1 = maximal asymmetry) from 3D photogrammetry at 3 months, operative time, intraoperative perfusion (laser-Doppler flux), and early complications. Statistics: independent-samples t-tests, χ² tests, mixed-effects ANOVA (α = 0.05).

Results.Baseline demographics and cleft severity were comparable (all p > 0.30). Mean OFS improved from 3.1 ± 0.5 (Control) to 4.7 ± 0.4 (EVI), mean difference 1.6 (95 % CI 1.2–2.0; p < 0.001). Three-month NSI was lower in EVI (0.09 ± 0.03) versus Control (0.16 ± 0.05; p = 0.001). Operative time increased by 5.8 ± 2.7 min with EVI (p = 0.04). There were no significant differences in laser-Doppler perfusion or early complication rates (one wound-edge dehiscence per group).

Conclusion.The extended vestibular-alar incision strongly affects the operative exposure in a positive way and the early nasal symmetry is maintained after the operation without any perfusion or safety problems that are only a minor increase in the operating time. The routine facilitation of EVI may allow more precise cartilage manipulation and lead to a decrease in the early secondary revision rates.

Keywords: cleft lip,rhinocheiloplasty, extended vestibular-alar incision,operative exposure,nasal symmetry.

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