Cleft Rhinoplasty

Overview

The authors state that understanding the anatomy and underlying mechanism of the cleft nasal deformity is essential to managing it and to selecting the right repair techniques. Timing of the intermediate and definitive operations should be considered carefully, with the definitive rhinoplasty performed after any facial skeletal deformities have been treated.

Sections of note

• Review article; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• Definitive rhinoplasty should occur after management of facial skeletal deformities.
• At that operation, the septum must be individually considered.
• The external and internal nasal valves must be considered.
• Alar base malposition and the corresponding bony deficiency must be addressed.
• The position and shape of the lower lateral cartilage and the columella must be considered.
• The authors state thorough knowledge of rhinoplasty technique is crucial to achieving good function and appearance.

What it means for a patient

• Cleft nasal correction is staged across childhood and adulthood, with the final operation deliberately left until the facial bones are settled and treated.
• The bony foundation under the nostril is deficient on the cleft side, so the nose sits on an uneven base.
• Each part of the nose is assessed separately because the deformity affects them differently.
• This is expert guidance. No outcome data or revision rates are reported.

Why this paper matters

Sequencing is the central decision in cleft nasal care, since operating before the skeleton is corrected commits the surgeon to a base that will change. This review states that principle and the checklist for the final operation. It provides no evidence comparing timing strategies.

Terms

• Cleft nasal deformity: the asymmetric nose accompanying a cleft lip.
• Definitive rhinoplasty: the final nasal operation, performed once growth and skeletal correction are complete.
• Intermediate rhinoplasty: an interim operation performed during childhood.
• Alar base malposition: the base of the nostril sitting in the wrong position.
• Internal nasal valve: the narrowest part of the nasal airway.
• Lower lateral cartilage: the paired cartilage forming the nasal tip.