Revision of the Cleft Lip Nose

Abstract

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.

Keywords

cleft - rhinoplasty - revision

• References

• 1 Wang TD, Madorsky SJ. Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip. Arch Facial Plast Surg 1999; 1: 40-45
• 2 Sykes JM. The importance of primary rhinoplasty at the time of initial unilateral cleft lip repair. Arch Facial Plast Surg 2010; 12: 53-55
• 3 McComb HK, Coghlan BA. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac J 1996; 33: 23-30 ; discussion 30–31
• 4 Shih CW, Sykes JM. Correction of the cleft-lip nasal deformity. Facial Plast Surg 2002; 18: 253-262
• 5 Wang TD. Secondary rhinoplasty in unilateral cleft nasal deformity. Clin Plast Surg 2010; 37: 383-387
• 6 Wang TD. Secondary rhinoplasty in unilateral cleft nasal deformity. Facial Plast Surg 2007; 23: 123-127
• 7 Millard DR. Cleft Craft: The Evolution of its Surgery. Vol.1: The Unilateral Deformity. Philadelphia: Lippincott Williams & Wilkins; 1996
• 8 Millard DR. Rhinoplasty in congenital anomalies. In: A Rhinoplasty Tetralogy: Corrective, Secondary, Congenital, Reconstructive . Philadelphia: Lippincott Williams & Wilkins; 1996: 211-320
• 9 Fujimoto T, Imai K, Hatano T, Takahashi M, Tamai M. Follow-up of unilateral cleft-lip nose deformity after secondary repair with a modified reverse-U method. J Plast Reconstr Aesthet Surg 2011; 64: 747-753
• 10 Ayhan M, Gorgu M, Erdogan B , et al. Various applications of chondrocutaneous composite grafts in secondary cleft lip nose patients. J Craniofac Surg 2006; 17: 1065-1071
• 11 Carlino F. Modified forked flap for controlling columella length in cleft lip open rhinoplasty. J Craniomaxillofac Surg 2008; 36: 131-137
• 12 Turkaslan T, Turan A, Yogun N, Ozsoy Z. A novel approach to cleft lip nose deformity: posterior dome graft technique. J Craniofac Surg 2008; 19: 1359-1363
• 13 Flores RL, Sailon AM, Cutting CB. A novel cleft rhinoplasty procedure combining an open rhinoplasty with the Dibbell and Tajima techniques: a 10-year review. Plast Reconstr Surg 2009; 124: 2041-2047
• 14 Lee TS, Schwartz GM, Tatum SA. Rhinoplasty for cleft and hemangioma-related nasal deformities. Curr Opin Otolaryngol Head Neck Surg 2010; 18: 526-535
• 15 Huempfner-Hierl H, Hemprich A, Hierl T. Results of a prospective anthropometric and functional study about aesthetics and nasal respiration after secondary rhinoplsty in cleft lip and palate patients. J Craniofac Surg 2009; 20 (Suppl. 02) 1863-75
• 16 Sandor GK, Ylikontiola LP. Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate. Int J Maxillofac Surg 2006; 35: 407-411
• 17 Chaithanyaa N, Rai KK, Shivakumar HR, Upasi A. Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients. J Plast Reconstr Aesthet Surg 2011; 64: 27-33
• 18 Pitak-Arnnop P, Hemprich A, Dhanuthai K, Pausch NC. Outcome research on secondary cleft rhinoplasty: the Leipzig experience. J Plast Reconstr Aesthet Surg 2011; 64: 277-278