Nasal Deformity in Association with Cleft Lip - Management from Infancy to Adulthood

Abstract

Nasal deformity in association with a cleft lip is quite characteristic and remains to be a stigma for the individual with this deformity. As a newborn, a cleft lip is the most obvious deformity viewed by average individuals and parents, but in the long-term it is the nose. Most of the previously described corrective techniques for addressing the nasal deformity associated with a cleft lip have focused on the dermal approximation of the adjacent lip by securing the freed cartilages to the skin temporarily and repositioning the nasal tip cartilages. We developed a corrective technique in which the nose is effectively lifted and suspended internally to the radix in a semi-closed manner. Secondary corrections to the nose or lip in childhood should be avoided unless problems in these areas are causing psychological disturbances. In such situations, minimal incisions and/or old lip scars should be used for access. Introduction of scars to the columella must be avoided in children, as this procedure hinders future formal cleft rhinoplasty. Unilateral cleft-associated nasal deformity has been more challenging due to the relative asymmetry compared to the bi-lateral counterpart. Secondary cleft septo-rhinoplasty is considered a challenging operation requiring significant surgical expertise. In adults, an open tip approach is required in addition to the use of sturdy cartilage grafts to augment the columella, tip, and dorsum, and to address functional nasal issues. In cases of severe and or poorly treated bilateral cleft lips and nasal deformities in adults, the nose and columella are first to be reconstructed with prolabial flap followed by an Abbe flap to the lip.