Cleft Nose Reconstruction (Rhinoplasty)
Repair of cleft nose deformities - The ULTIMATE Clinical pearls, continued 6. All unilateral cleft deformities present with deviated or buckled cartilaginous nasal septa, which often involves the vomer-bone, too. A septoplasty, often combined with a turbinate plasty, is mostly indicated, due to the asymmetrical nasal blockage of the airway. This should be performed with the rhinoplasty during the same anaesthesia. However, the septoplasty should be completed before eventual indicated nasal osteotomies. 7. The septum cartilage is the preferred cartilage for transplantation to the superior lateral crura and/or dome and/or columella and/or nasal sill. For more extensive augmentation, rib grafts can be used for nasal bridge repair, with or without additional columella support. 8. The cleft nose repair in patients with bilateral cleft deformity is usually less difficult, as the nasal structure and its deformities are generally symmetrical. In bilateral cleft nose deformities, the columella length and the domeâ€™s appearance, are the major areas of concern. Addressing these issues provides optimal aesthetic results regarding the nasal tip, as well as the supra-tip break, especially by narrowing the intermediate crura in the dome. 9. For long-term post-operative support of the transplanted cartilage, additional resorbable plates or sheets (e.g. PdLAlLA) can be used. This eventually reduces secondary surgical interventions for the nasal framework (skin, cartilage and bone).
Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...