Revision of the Cleft Lip Nose

Abstract

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.

Eye tracker based study: Perception of faces with a cleft lip and nose deformity

“…It seems that facial skeleton growth is mainly influenced by palatal closure (Von den Hoff et al, 2006;Kremanak et al, 1967Kremanak et al, , 1970Fudalej et al, 2013). The definitive rhinoplasty is performed in adolescence or young adulthood whereas the intermediate rhinoplasty is performed between primary rhinoplasty and definitive rhinoplasty to achieve more symmetry during nasal growth and to create a platform for the definitive rhinoplasty (Angelos and Wang, 2012). The moment to perform the intermediate rhinoplasty can vary and may occur before orthodontic alignment and bone grafting (4-6 years) or afterwards (8-12 years).…”

The Surgical Nasoalveolar Molding: A Rational Treatment for Unilateral Cleft Lip Nose Deformity and Literature Review

“…Observed complications were low (5.4% of scar contracture and 2.7% of synechia) in comparison with similar studies, and all were well addressed without any additional surgery. 29 , 30 There were no cases of lip dehiscence in this group of patients independent of cleft severity (wider than 15 mm), illustrating that presurgical orthopedics are not necessary to prevent this complication.…”

Secondary Cleft Rhinoplasty in 1720 Patients: Are National Practices Consistent With Guidelines?

“…Addressing the cleft nose at time of primary cleft lip repair can allow most patients to defer definitive cleft rhinoplasty until skeletal maturity (Guyuron, 2008;Mulliken and Kim, 2013). Secondary cleft rhinoplasty is often performed during childhood in the setting of severe deformity or psychosocial distress (Guyuron, 2008;Angelos and Wang, 2012). Surprisingly, the mean age for cleft rhinoplasty was low at 9.3 years with the CPT code for more extensive rhinoplasty also used in a population of patients who were primarily preadolescent (Zankl et al, 2002;Johnson, 2017).…”

“…Addressing the cleft nose at time of primary cleft lip repair can allow most patients to defer definitive cleft rhinoplasty until skeletal maturity (Guyuron, 2008; Mulliken and Kim, 2013). Secondary cleft rhinoplasty is often performed during childhood in the setting of severe deformity or psychosocial distress (Guyuron, 2008; Angelos and Wang, 2012).…”