28. Cleft Lip Rhinoplasty

Page 1

Cleft Lip Rhinoplasty

28.

Definitive Rhinoplasty for Adult Cleft Lip Nasal Deformity §

§ §

§

§

§

§

The cleft nasal deformity is a three-dimensional abnormality involving all layers of the nose, beginning with the skeletal platform and extending into the vestibular lining, cartilaginous infrastructure, and external nasal skin.2 The fact that cleft noses have abnormalities in all tissue layers separates them in kind and difficulty from most cosmetic rhinoplasties. At adolescence the nasal bones, ULCʼs, and septum begin to rapidly expand anteriorly and vertically. At the same time the LLCʼs (alar cartilages) become more convoluted until they take on the adult dimensions and the specific, complex, mirror image forms that make an adult nose appear normal, deformed, beautiful, or ugly. Children with significant secondary cleft lip nasal deformities have to be rebuilt with cartilage grafts after the adolescence period has passed (at age 15 in females and 17 in males). Open rhinoplasty after the nose has reached adult proportions allows the surgeons to construct a new alar cartilage framework over the hypoplastic alar cartilage and rebuild a new tip. This often requires grafts from the nasal septum (strong hyaline cartilage but short supply), conchae of the ears (relatively weak), or costal cartilages (choice for larger reconstructions requiring strong anterior projection). The goals of septorhinoplasty are to maximize functional nasal breathing and to optimize nasal and facial appearance. In most cases, the skeletal foundation, both dental and craniofacial, should be stabilized before performing definitive nasal surgery.


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.