Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

Abstract

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.

“Septoplasty” Performed at Primary Cleft Rhinoplasty: A Systematic Review of Techniques and Call for Accurate Terminology

“…Our included articles consisted of 11 studies describing primary cleft septoplasty and 17 studies describing secondary cleft septoplasty (Table 2, Table 3). 1,6–32 We defined primary cleft septoplasty as septoplasty performed at primary cleft lip repair. Secondary cleft septoplasty included all septoplasty performed at a secondary cleft lip or nasal revision, with the lowest listed age to be 14 years, “after skeletal maturity,” or “after multiple cleft nasal operations.”…”

How Deviation of Nasal Septum Affects Nasal Appearance in Unilateral Cleft Patients: A Study Using Cone-Beam Computed Tomography

“…9 As the nasal septum provides a stable framework when adjusting nasal abnormalities, surgeons believe that reconstruction of the nasal septum in definitive rhinoplasty is critical. 8,10 However, less quantitative analysis to show how nasal septum deviation affects nasal appearance in unilateral cleft patients to support the current cleft rhinoplasty strategy. This study is aimed to quantitatively evaluate the relationship between nasal appearance and nasal septum deviation in unilateral complete cleft patients using cone-beam computed tomography (CBCT).…”

“…As the nasal septum provides a stable framework when adjusting nasal abnormalities, surgeons believe that reconstruction of the nasal septum in definitive rhinoplasty is critical 8,10 . However, less quantitative analysis to show how nasal septum deviation affects nasal appearance in unilateral cleft patients to support the current cleft rhinoplasty strategy.…”