Nasal Deformities and their Treatment in Secondary Repair of Cleft Lip Patients:A Clinical Study of 175 Cases

The author reports his own experience in 175 cases of secondary repair of cleft lip nose deformities. In spite of the great variability of these cases a relatively simple strategy has been defined, based on a precise study of the lesions. In unilateral cases the nose is deviated entirely to the normal side, not only because of nasal bone deviation but also and mainly because of septal deviation. The nasal tip is distorted because of the alar cartilage displacement which results from bone deviation. Rhinoplasty is usually performed by a submucosal approach through a vertical incision in the columella. It includes septal straightening, nasal osteotomies, and sharp dissection and reduction of the triangular cartilages and alar cartilages to allow of their suturing in the normal position. In bilateral cleft lip cases the main deformity of the nose is shortness of the columella. Here, two techniques have been utilized. In those rare cases where the lip was correct in height and width, a V—Y plasty on the nasal tip was performed with good results. In most cases the Abbe-Estlander flap was the procedure of choice. These rhinoplasties were carried out on patients between 15 and 20 years of age, and were always considered to be the last stage of secondary cleft lip repair, particularly after the maxillary bone defects had been corrected.