Reconstruction necessitated by severe hypoplasia or a columella defect.

In reconstruction necessitated by severe hypoplasia or a columella defect, the surgeon must consider various factors in each case, such as the characteristic columellar shape, color match, texture, patient age, original disease, and surrounding scars. In these cases, reconstruction of both the cartilaginous strut and the overlying skin is necessary and important to obtain good results. The authors report three cases of reconstruction of the columella with satisfactory results. Case 1 involved a 6-year-old girl with complete bilateral cleft lip and severe hypoplasia of the premaxilla and prolabium. Columellar reconstruction was performed with small triangular flaps at the columella base, together with a rib chondral graft for cartilaginous support. Case 2 involved a 12-year-old girl with a complete bilateral cleft lip and cleft palate. Columellar reconstruction was performed with small triangular flaps at the columella base, together with bilateral conchal cartilage grafts. Case 3 involved a 17-year-old boy with a right complete cleft lip and columellar defect caused by previous infection after secondary cheiloplasty. Columellar reconstruction was performed using a left nasal vestibular flap and septal cartilage grafting, together with a bilateral conchal cartilage graft beneath the flap. The authors consider the unilateral nasal vestibular flap to be very useful in carefully selected unilateral cleft cases.