Cleft Rhinoplasty

Abstract

Cleft rhinoplasty is one of the most difficult and challenging aesthetic surgeries to carry out and bears a significant impact on the overall nasal aesthetics and function. Two reasons understood for this are the simultaneous involvement of all the layers of the nose including the skin, cartilage, skeleton and vestibular lining (this being the principal reason) and the significant scarring that is the consequence of multiple previous surgical interventions. There is a mention of numerous techniques for ultimate correction of unilateral and bilateral cleft nasal deformities but no single technique has till date provided a definite solution for correction of all the problems that accompany these deformities. There is a revised interest in performing primary rhinoplasties at the time of lip repair with or without presurgical orthopedics but these procedures may still warrant definitive rhinoplasty at a later date. The purpose of this chapter is to provide a comprehensive review of cleft rhinoplasty in the most systematic manner beginning with the pathologic anatomy followed by surgical timing, pre-operative evaluation and surgical correction. The chapter also discusses the use of various grafts in a typical cleft rhinoplasty case as well as treatment strategy for management of both, unilateral and bilateral cleft nasal deformities. The outcomes as well as complications and a note on further revisions have also been presented.