Our Summary

This research paper discusses the complexities involved in nose reshaping surgeries (rhinoplasties) on patients who have had a cleft lip or palate. These surgeries are particularly challenging due to previous manipulations and scarring of the tissue. One unique issue is that the tissue often needs extra support, which can be provided through sturdy grafts made of cartilage.

The paper highlights that rib grafts are especially useful, as they provide a large amount of cartilage that can be used in multiple areas. It also points out that the ability to change and adjust the thickness of the cartilage strut (the supportive framework) can help improve the graft’s resistance to deformation and distortion caused by scar tissue. This is particularly important for patients with unilateral cleft deformities, where only one side of the mouth is affected.

FAQs

  1. What makes septorhinoplasties in cleft patients particularly challenging?
  2. Why is it typically necessary to place cartilaginous grafts during unilateral cleft rhinoplasties?
  3. What are the benefits of using a rib graft in cleft rhinoplasty?

Doctor’s Tip

One helpful tip a doctor might tell a patient about rhinoplasty is to have realistic expectations about the outcome. It’s important to understand that while rhinoplasty can improve the appearance of the nose, it may not always result in perfection or meet every expectation. It’s crucial to communicate openly with your surgeon about your goals and concerns to ensure you both have a clear understanding of what can be achieved. Additionally, following post-operative care instructions and attending follow-up appointments are essential for a successful recovery.

Suitable For

Patients who are typically recommended for rhinoplasty include those with congenital deformities such as cleft lip and palate, as well as patients with functional issues such as breathing difficulties or nasal obstruction. Additionally, individuals who are dissatisfied with the appearance of their nose and desire cosmetic improvement may also be candidates for rhinoplasty. It is important for patients to have realistic expectations and be in good overall health before undergoing rhinoplasty surgery.

Timeline

Before Rhinoplasty:

  1. Consultation with a plastic surgeon to discuss goals and expectations of the procedure.
  2. Pre-operative assessment to evaluate the patient’s overall health and suitability for surgery.
  3. Discussion of surgical plan, including potential risks and complications.
  4. Pre-operative instructions, including avoiding certain medications and smoking.

After Rhinoplasty:

  1. Recovery period with swelling, bruising, and discomfort.
  2. Follow-up appointments with the surgeon to monitor healing progress.
  3. Gradual improvement in appearance as swelling subsides.
  4. Possible need for pain medications and antibiotics.
  5. Return to normal activities after a few weeks, with final results becoming apparent over several months.

What to Ask Your Doctor

  1. What specific improvements can be made to my nasal appearance with rhinoplasty?

  2. What are the risks and potential complications associated with rhinoplasty surgery?

  3. How long is the recovery period after rhinoplasty surgery and what can I expect during this time?

  4. Will I need to undergo any additional procedures in the future to maintain or enhance the results of my rhinoplasty surgery?

  5. How many rhinoplasty procedures have you performed on cleft patients and what is your success rate?

  6. Can you provide me with before and after photos of previous cleft rhinoplasty patients you have treated?

  7. What is your approach to addressing scarring and tissue manipulation in cleft rhinoplasty procedures?

  8. What type of cartilage grafts do you typically use for cleft rhinoplasty and why?

  9. How long can I expect the results of my cleft rhinoplasty to last?

  10. Are there any non-surgical options or alternative treatments that may be considered before undergoing rhinoplasty surgery?

Reference

Authors: Cuzalina A, Jung C. Journal: Oral Maxillofac Surg Clin North Am. 2016 May;28(2):189-202. doi: 10.1016/j.coms.2015.12.002. Epub 2016 Mar 5. PMID: 26960915