ABSTRACT
Discussion on recent trends and controversies in primary cheilorhinoplasty for bilateral cleft lip and palate. In the conservative technique, the alar cartilages are approached medially from the prolabium by tunnelling under the columella and laterally from the alar bases. This is combined with a limited amount of subperichondrial nasal septal dissection for repositioning of the medial crura. In the retrograde technique, the approach is posterior to the medial crura and utilises an extended prolabial incision up through the membranous septum. The alar cartilages are hence accessed through a retrograde approach. Lastly, the anterograde approach is anterior to the medial crura where the prolabial incision is continued subcutaneously up the lateral aspect of the columella superficial to the alar cartilages, together with a separate intranasal rim incision. Although this increases columella length, it also increases nasolabial angle, columellar, and inter-alar width, which are unsatisfactory results.
