Background: The well known congenital cleft lip and palate deformity affects much more than its name alone indicates. Affected as much as the lip is the nose from its internal breathing structures to its external appearance.
While the nose in the cleft patient may be treated during surgery as an infant or child, these early efforts do not avoid the need for a definitive nasal procedure as a teenager or an adult. The teenage years is when a more thorough and aggressive approach may be taken to a rhinoplasty procedure. The septum, turbinates and any amount of cartilage grafting can be done to the nose without risks of any adverse growth effects.
Like the cleft nose deformity, the cleft lip can almost always be improved during the teenage years. Fortunately most of these cleft lip revisions are minor and can easily be combined with an open cleft septorhinoplasty procedure.
Case Study: This 15 year-old teenage male was born with a unilateral cleft lip and palate deformity. He had been through primary cleft lip, palate and alveolar bone grafts repairs. He waited until his teenage years to formally address his cleft nasal deformity. He had all of the typical cleft-related nasal changes including a large septal deviation away from the cleft side, large inferior turbinate enlargement, a wide nasal tip with thick skin, a slump ed ipsilateral lower alar cartilage, a widened nostril, wide nasal bones and a skeletal defieciency under the left cleft nostril base. He also had a disruption along the vermilion-skin border along the philtral scar line of the left upper lip.
Under general anesthesia he underwent a combined open septorhinoplasty with a cleft lip revision at the cupid’s bow area. Cartilage grafts used for the nose came from his septum. His results six months later showed a better nasal appearance with an improved nasal tip and left nostril shape. He could breathe better through both sides of his nose. In addition, his cleft lip scar was better aligned along the cupid’s bow area.
The more complete cleft septorhinoplasty occurs during the teenage years. I prefer to do it early in the patient’s teen years for social and self-image reasons. There are no growth concerns at this age. Cleft nasal surgery would be delayed if orthognathic surgery needs to be done as a maxillary advancement will have a significant alteration of the nasal skeletal base.
Highlights:
1) The cleft lip and palate deformity causes significant malformations of the nose as well.
2) The cleft nasal deformity is one of the mot challenging in all of rhinoplasty due to both tissue displacements and tissue deficiencies.
3) An open cleft septorhinoplasty can be combined with cleft lip revision for a more definitive repair during the teenage years.
Dr. Barry Eppley
Indianapolis, Indiana