Cleft lip rhinoplasty

The secondary cleft lip nasal deformity presents an extreme challenge to the facial plastic surgeon. The deformity is complex and involves all tissue layers, including skeletal platform, inner lining, osseocartilaginous structure, and overlying skin. It is often the characteristic cleft nasal deformity that is noticeable to the observer after a well performed cleft lip repair. Secondary repair of the cleft lip nasal defect requires an understanding of the pathological nasal anatomy associated with congenital clefting. The basic cleft nasal deformity is characteristic and defendant upon the original extent of clefting of the lip. However, the secondary nasal defect varies greatly and is a result of: 1) the original malformation, 2) any interim surgery performed, and 3) growth of the nose and face. The cleft surgeon must therefore have a treatment philosophy and technique flexible enough to reconstruct a variable range of associated nasal problems. This chapter describes the pathological anatomy associated with cleft deformities, and describes approaches and techniques designed to improve form and function of the cleft nose.