Fig. 3. Operative views from case 2. (A) Initial diagnosis shows a severely rotated and protruding premaxilla with a very wide gap on the left-sided cleft. (B) Vomer ostectomy is performed posterior to the vomero-premaxillary suture through a vertical incision on the vomer crest. (C) The left-sided inferior turbinate flap is prepared. (D) The right-sided inferior turbinate flap is prepared. (E) The superior margin of the turbinate flap is sutured to the pyriform margin, while the inferior margin is sutured to the mucosal part of the lateral nasal flap, forming the lateral tissue for nasal floor lining. (F) The lateral tissue framework is advanced medially, with the cutaneous part sutured behind the columella to reconstruct the nasal sill. The C-mucosal flap is sutured to the free margin of the inferior turbinate flap to reconstruct the nasal floor. (G) Functional muscular reconstruction is performed. (H) The operation is finalized with primary rhinoplasty using bilateral reverse-U incisions.
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