[Outcome of Van der Meulen columellar extension in bilateral lip-jaw-palate clefts].

A total of 42 patients were operated on for secondary columellar elongation at the Department for Cranio-maxillofacial Surgery in Essen, Germany, from 1990 to 1996. The procedures were carried out because of nasal deformity in bilateral cleft lips (n = 35) or unilateral cleft lips (n = 7). The well-established drawbacks of Millard's forked flap technique, especially the resulting unfavourable scars at the lip columellar angle and the unpredictable, more conspicuous scar formations within the upper lip gave rise to an intensive search for an alternative surgical technique in our clinic. Since 1995 we have undertaken 14 secondary columellar elongations by means of Van der Meulen's three dimensional Z-plasty at the alar rim. Avoiding reopening of the lip we were able to lengthen the columella and project the nasal tip forward between 3 mm and 8 mm in all patients without introducing additional visible scars. The procedure led to an improved contour of the nasal tip, the alar rims and the nostrils. Nevertheless, we observed secondary broadening and shortening of the elongated columella in two children. This complication could subsequently be avoided by postoperative application of a nostril splint. The results confirm the effectiveness of the described technique for moderate columellar lengthening. The postoperative application of nostril splints is mandatory.