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Unilateral Cleft Nose Reconstruction / Primary Rhinoplasty

Unilateral primary rhinoplasty – The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal aesthetic and functional results in unilateral primary rhinoplasty. 1. Extensive dissection of the nasal dome, superior alar and septal cartilages, may lead to nasal growth disturbance resulting in adults with infant-like noses. 2. Release the obliquely positioned septum cartilage from the hard palate and anterior nasal spine for around 5 to 8 mm, to achieve auto-correction during growth and a more straight anterior nasal septum. 3. Intrauterine, cleft side alar cartilages are mostly concavely moulded. Do not carve this alar cartilage to weaken its concave shape. Release the mucosa from the cartilage. Insert as a support additional resorbable material between the nasal mucosa and deformed cartilage. (Note: in adolescents/adults it should be placed between skin and alar cartilage). 4. 0.3mm thick PdLAlLA sheet, moulded according to the ala shape of the non-cleft side, may help to support the cleft sided concave alar cartilage deformity. 5. The resorbable material can be underpinned onto the dento-alveolar arch to support the nasal structure at the nasal alar sill region. 6. To avoid nasal growth disturbance, secondary rhino-septoplasty should generally be performed after the age of 14 years, even though the nose will become more asymmetric during growth. 121

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Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

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