Fig. 21-16 Tajima Repair. A. With gentle pressure on the ala the nostril is elevated, and the position of the reverse U incision is marked symmetrically with the non-cleft side. B-G. These figures demonstrate the use of the cleft nasal retractor for placement of the suspending sutures, as demonstrated in the subsequent intraoperative images. Following wide undermining of the skin to free the skin envelope from the underlying cartilage, the cleft nasal retractor is used for positioning the sutures for suspension of the displaced cartilage. The cleft retractor is placed between cartilage and skin, and the sutures are passed with a straight needle passing through mucosa, cartilage, retractor, and skin. Once the other end of the suture is passed similarly, starting 3-4 millimeters from the first, the retractor is withdrawn, and the free ends of the suture pass back through the skin and through the incision. One end is then ready for placement through the cleft side alar cartilage. H. The three suspending sutures used in the unilateral cleft nasal repair are illustrated. I.-K. The incision is outlined after gentle elevation of the displaced cartilage showing the orientation of the incision from 3 views. L. The skin envelope is freed extensively from both upper and lower lateral cartilages bilaterally. M. – O. The clear nylon sutures are passed through upper lateral cartilage on both contralateral and ipsilateral sides, and through the contralateral dome using the cleft retractor as illustrated above. P. Each of the three sutures are passed through the cleft alar cartilage. Ipsilateral upper lateral cartilage to lateral cleft ala, contralateral upper lateral to just lateral to the dome of the cleft ala, and from dome to dome. Q. The sutures are tied, stopping each at the symmetrical position to the normal side. The extra tissue gained with the initial flap outline moves inward to provide the additional lining tissue. R. – S. Two views of the final correction. (A., B. – G: From Kernahan Da, Bauer BS, Harris GD. Experience with the Tajima procedure in primary and secondary repair in unilateral cleft lip nasal deformity. Plast Reconstr Surg.66:46-53; H: Courtesy Margie Aitken)

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