Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

Overview

People born with a cleft usually have several nose operations, and each one leaves scars, grafts, and altered tissue behind. This article describes the authors' preferred approach to the nose that has been operated on repeatedly, and the surrounding problems that must be assessed alongside it.

Sections of note

• Revision cleft rhinoplasty is described as a further tier of difficulty beyond standard rhinoplasty.
• Symmetry, proportions, and definition are affected by the original cleft deformity plus previous surgical scars, cartilage grafts, and skin excisions.
• The preferred approach uses structural cartilage grafting to establish resiliency of the septum and the lower lateral cartilages.
• Deficiency of the internal lining is addressed with skin or lining transfer.
• Excess thickness at the nasal tip is contoured to improve definition.
• The cleft nasal deformity must be considered together with the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.
• No patient numbers, outcome rates, or follow-up are reported in the abstract.

What it means for a patient

• Previous operations, not just the original cleft, shape what a revision has to correct.
• Lining shortage inside the nose is a distinct problem from cartilage shortage and needs its own solution.
• The bite and the upper jaw position influence the nose, so assessment extends beyond it.
• This is a review of expert practice with no measured outcomes, so it does not report success rates.

Why this paper matters

The multiply operated cleft nose is among the hardest problems in facial surgery, with progressively less usable tissue at each attempt. Framing it as a combined lip, bite, jaw and nose problem is the central point. No data is given on how the described strategy performs.

Terms

• Cleft nasal deformity: The nasal shape resulting from a cleft lip and palate present from birth.
• Structural cartilage grafting: Placing cartilage to hold shape and resist collapse over time.
• Lower lateral cartilage: The paired cartilage forming the nasal tip and nostril rim.
• Internal lining: The skin and mucosa lining the inside of the nose.
• Dentofacial occlusion: How the upper and lower teeth meet.
• Maxillary deficiency: Underdevelopment of the upper jaw.