Cleft - Ultimate Treatment
Repair of cleft nose deformities - 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. 1. Accurate aesthetic planning with drawings of various aspects of repair such as soft tissue, cartilage and bone of CL, CLA, and CLAP abnormalities is essential, to accurately execute surgery and predict post-operative outcome. 2. Often the optimal aesthetic effect cannot be achieved at one go, especially in unilateral cleft nose deformities. In secondary surgeries, quite often additional cartilage and/or resorbable plates/sheets have to be used to ultimately mould nasal structures in order to achieve the best result. 3. In unilateral cleft nose deformities the alar margin of the cleft side (â€œthe hanging rimâ€?) often requires specific soft tissue repair, without involving the superior part of the lateral alar cartilage. This part of the alar usually shows a deformed facet and the cartilage should be preserved to avoid alar collapse. 4. An open-sky nasal approach is indicated in most cases. A slight columella lengthening which projects the nasal tip can be achieved using a Carolina incision. The standard transcolumellar v-shape incision is only indicated in a preoperative perfect superior nasal tip projection. 5. On the cleft side, quite often, an intra-nasal mucosal-cartilage band pulls the lower lateral cartilage at the nasal facet region inferiorly and this band has to be released with a z-plasty or an ellipse with cartilage removal.
Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...