Controversies in Cleft Rhinoplasty

Overview

Cleft lip nasal deformity varies widely between patients, and previous operations add scarring and surgeon-caused changes. This review sets out where practice is contested, what evidence supports particular techniques, and the authors' own preferences across the staged course of treatment.

Sections of note

• Rhinoplasty for cleft lip nasal deformity is described as challenging all cleft surgeons.
• There is great variability of anatomy, compounded by surgeon-caused changes and scarring from previous operations.
• The approach must be tailored to each patient, changing both function and appearance.
• In the primary setting, nasoalveolar molding is used as presurgical infant orthopaedics before the cleft lip and nose repair.
• Intermediate stages should be conservative to minimize scarring.
• The definitive cleft rhinoplasty uses cartilage grafts from septum, ear, or rib to sculpt the nose.
• The article outlines controversies, the evidence supporting certain techniques, and the authors' preferences.

What it means for a patient

• Treatment is staged from infancy to adulthood, with different aims at each stage.
• Doing less at the intermediate stage is deliberate, since each operation adds scar tissue that constrains the final one.
• The final operation uses cartilage grafts, with the source depending on what is available.
• This is a review with no measured outcomes, so it does not report success or revision rates.

Why this paper matters

Cleft nasal care spans decades and each stage limits what the next can achieve, so sequencing decisions matter more than in standard rhinoplasty. Naming the controversies rather than presenting one method as settled is useful. The review does not resolve them with data.

Terms

• Cleft lip nasal deformity: The nasal shape resulting from a cleft lip present from birth.
• Nasoalveolar molding: Using tape or a custom appliance before surgery to reshape an infant's gum and nostril.
• Presurgical infant orthopaedics: Shaping the infant's facial structures before the first operation.
• Intermediate rhinoplasty: A nose operation in childhood, between the first repair and the final one.
• Definitive rhinoplasty: The final nose operation, generally after facial growth is complete.
• Iatrogenic: Caused by the medical treatment itself.