Secondary cleft rhinoplasty

Overview

The nose of a person born with a cleft lip is distorted by the underlying anatomy and by scars from earlier repairs, making the definitive secondary rhinoplasty hard even for experts. Many techniques have been published but none is widely adopted. The authors review the field and the state of outcome research.

Sections of note

• Review article; no patient series or outcome figures in the abstract.
• Covers unilateral and bilateral cleft nasal deformity.
• Fundamental goals: nasal symmetry with definition of the base and tip, correction of airway obstruction, repair of scarring or webbing.
• The lack of wide adoption of any single technique reflects the variability of the deformity.
• Very few studies have looked specifically at outcomes of secondary cleft rhinoplasty.
• Topics reviewed: anatomy, repair strategies and timing, surgical techniques, outcomes.

What it means for a patient

• A cleft nose repair aims at symmetry, a defined tip and base, clear breathing and removal of scar bands.
• Approaches differ between surgeons because each cleft nose is different; there is no single standard operation.
• Evidence on how well these operations work is thin, so outcome expectations should be discussed individually.

Why this paper matters

It is a current overview from a facial plastic surgery perspective and states plainly that the outcome literature is inadequate. It offers no new data itself.

Terms

• Cleft lip: a birth gap in the upper lip, with or without a cleft palate, that distorts the nose.
• Secondary cleft rhinoplasty: the definitive nose operation done after earlier cleft repairs.
• Unilateral: affecting one side; bilateral: affecting both sides.
• Nasal base: the bottom of the nose, including the nostrils and the columella.
• Webbing: a scar band across the nostril opening.
• Nasal airway obstruction: blocked breathing through the nose.