BACKGROUND: Repositioning of the lower lateral cartilages during primary cleft lip and nose repair is challenging. McComb published a technique for cleft nose repair by suspending the lower lateral cartilage to the ipsilateral upper lateral cartilage. Subsequently, Tajima described suspension to the contralateral upper lateral cartilage. Placement of this suture during a primary cleft repair is difficult. Practitioners must often resort to the use of external bolsters or specially designed instruments solely for this purpose.
METHODS: We describe a single-surgeon series of primary cleft nose repairs using a modification of the Tajima technique in patients with unilateral cleft lip and nose deformities. The lower lateral cartilage on the cleft side is suspended to the contralateral upper lateral cartilage using a buried semi-permanent suture through a reverse-U incision. The sutures are passed transcutaneously through a hollow needle.
RESULTS: A modified Tajima primary cleft nose repair was performed on 12 patients with unilateral cleft lip and nose deformities. Seven patients were male, and five were female. Eight cases were complete and four were incomplete clefts. The average age was 6.7 months and average follow-up was 4.4 months. All 12 patients demonstrated adequate repositioning of the lower lateral cartilage, improved tip symmetry, and effacement of the alar web. Many patient demonstrated over-correction of the defect, which was maintained in follow-up. No postoperative infections, complications, or extruded sutures were observed.
CONCLUSIONS: Our results indicate that a simple modification to the Tajima technique allows easy suture placement without bolsters or special instruments. Adequate suspension and medialization of the lower lateral cartilage is achieved using a buried, semi-permanent suture. Results are maintained in early follow-up. We anticipate long-term results will be maintained as well, if not better than other series, as placing a buried stitch without external bolster avoids the need for suture removal. Continued monitoring will allow us to confirm this.