Our Summary

This research paper talks about the need to understand the structure and issues related to cleft nasal deformity, which is a condition where a person has a split or opening in their nose, typically as a result of a cleft lip or palate. The paper emphasizes the importance of choosing the right surgical techniques to correct this deformity, and also the timing of these surgeries. The final, or “definitive”, surgery should take place after any deformities of the facial skeleton have been addressed.

During the final surgery, several factors should be considered, such as the septum (the wall separating the nostrils), the internal and external nasal valves (the parts of the nose that control airflow), the alar base (the base of the nostrils), and the position and shape of the lower cartilage and columella (the skin and cartilage dividing the nostrils).

In order to achieve the best results, both in terms of function (how well the nose works) and aesthetics (how the nose looks), a deep understanding of different surgical techniques is crucial.

FAQs

  1. What is the significance of understanding the anatomy and pathophysiology of the cleft nasal deformity in its management?
  2. When should intermediate and definitive rhinoplasty be considered in the process of cleft lip repair?
  3. What factors need to be considered at the time of definitive rhinoplasty for cleft lip repair?

Doctor’s Tip

One helpful tip a doctor might give a patient about cleft lip repair is to follow all post-operative care instructions carefully to ensure proper healing and optimal outcomes. This may include avoiding certain foods or activities, keeping the surgical site clean, taking prescribed medications as directed, attending follow-up appointments, and contacting the doctor if any concerning symptoms or complications arise. Compliance with post-operative care can help reduce the risk of complications and promote successful recovery.

Suitable For

Patients with a cleft lip and/or palate deformity are typically recommended cleft lip repair surgery. This may include infants and children born with a cleft lip and/or palate, as well as adults who have not previously undergone repair surgery. Additionally, patients with associated nasal deformities resulting from the cleft may also be recommended for cleft rhinoplasty to improve both functional and aesthetic outcomes. Timing of surgery and the specific techniques used will vary based on the individual patient’s needs and the extent of the deformity.

Timeline

Before cleft lip repair:

  • Prenatal diagnosis of cleft lip
  • Birth of the baby with cleft lip
  • Evaluation by a multidisciplinary team including plastic surgeons, otolaryngologists, speech therapists, and orthodontists
  • Preoperative counseling and preparation for surgery
  • Surgical repair of cleft lip usually performed between 3 to 6 months of age

After cleft lip repair:

  • Postoperative care and monitoring for complications
  • Follow-up appointments with the surgical team for assessment of healing and growth
  • Speech therapy and orthodontic treatment as needed
  • Planning for future surgeries such as cleft rhinoplasty
  • Definitive cleft rhinoplasty performed in adolescence or adulthood to address nasal deformities and optimize functional and aesthetic outcomes.

What to Ask Your Doctor

  1. What is the recommended timing for cleft lip repair surgery?

  2. What are the risks and potential complications associated with cleft lip repair surgery?

  3. How many surgeries may be needed to fully repair the cleft lip?

  4. What is the expected outcome in terms of appearance and function after cleft lip repair surgery?

  5. Will additional procedures, such as rhinoplasty, be needed to address the cleft nasal deformity?

  6. What are the options for addressing any speech or feeding issues associated with the cleft lip?

  7. What is the long-term follow-up plan after cleft lip repair surgery?

  8. Can you provide information about the surgeon’s experience and success rates with cleft lip repair procedures?

  9. Are there any specific pre-operative or post-operative instructions that should be followed for optimal results?

  10. Are there any support groups or resources available for patients and families dealing with cleft lip and palate issues?

Reference

Authors: Olds CE, Sykes JM. Journal: Clin Plast Surg. 2022 Jan;49(1):123-136. doi: 10.1016/j.cps.2021.08.002. Epub 2021 Oct 8. PMID: 34782130