scholarly journals Secondary Rhinoplasty On Cleft Lip Nose

1970 ◽  
Vol 1 (4) ◽  
Author(s):  
Gentur Sudjatmiko ◽  
Prasetyanugraheni Kreshanti
Keyword(s):  
Cleft Lip ◽  
Healing Process ◽  
Nasal Bone ◽  
Upright Position ◽  
Open Rhinoplasty ◽  
Nasal Deformity ◽  
Nasal Cartilage ◽  
Secondary Rhinoplasty ◽  
Cleft Lip Nose

By definition a secondary rhinoplasty is a procedure to correct the nasal shape deformity in cleft lip patients, which is performed not in conjunction with the labioplasty procedure. Several important factors to be considered in doing rhinoplasty procedures in cleft lip patients are: (1) Open rhinoplasty is more beneficial in assessing the whole nasal deformity, especially the nasal cartilage in cleft lip patients, (2) Releasing the latero-superior cartilage attached to the nasal bone and skin, which caused webbing inside the nostrils, (3) Addition of strut in columella as a pillar to adjust the dropping nose to the upright position, (4) Addition of cartilage plate whenever needed in the cleft side, (5) The nostril narrowing on the cleft side could be reduced by enlarging the nostril diameter, (6) The new nostril shape is maintained using a device (nasal retainer) for several weeks until the healing process is achieved, (7) The suture removal in nose is not as easy as of those in lip. The suture removal could be performed under mild sedation especially in uncooperative patients.

scholarly journals The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

2020 ◽  
Vol 5 (1-2) ◽  
pp. 53-62
Author(s):  
Badr M. I. Abdulrauf
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Nasal Bone ◽  
Case Series ◽  
Nasal Deformity ◽  
Challenging Issue ◽  
Primary Surgery ◽  
Novel Concept ◽  
Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

Cleft Lip Nose Correction Combining Open Rhinoplasty With the Dibbel Technique

2015 ◽  
Vol 26 (3) ◽  
pp. 682-686 ◽  
Author(s):  
Ayse Ozlem Gundeslioglu ◽  
Zeynep Altuntas ◽  
Irfan Inan ◽  
Fatma Bilgen ◽  
Lorenc Jasharllari ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Open Rhinoplasty ◽  
Cleft Lip Nose

scholarly journals Rhinoplasty in the Cleft Lip Patient

1997 ◽  
Vol 34 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Gilbert J. Nolst Trenité ◽  
Richard H.L. Paping ◽  
Albert H. Trenning
Keyword(s):  
Cleft Lip ◽  
Surgical Repair ◽  
Operative Procedure ◽  
Scar Tissue ◽  
Graft Material ◽  
Nasal Vestibule ◽  
Secondary Rhinoplasty ◽  
Custom Made ◽  
Postoperative Problems ◽  
Cleft Lip Nose

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided Into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.

scholarly journals Composite correction of a unilateral cleft lip nose deformity and alveolar bone grafting

2009 ◽  
Vol 42 (S 01) ◽  
pp. S71-S78
Author(s):  
Nitin J. Mokal ◽  
Chintamani Kale ◽  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Septal Cartilage ◽  
Alar Cartilage ◽  
Open Rhinoplasty ◽  
Cartilage Graft ◽  
Nasal Deformity ◽  
Alveolar Bone Grafting ◽  
Alar Rim

ABSTRACT Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there is no single established universally accepted method of correction. The open alveolar gap and the ipsilateral hypoplastic maxilla are two major problems in achieving consistently good results in a cleft lip nasal deformity. In our study, after first assuring the orthodontic realignment of maxillary arches, we combined bone grafting in the alveolar gap and along the pyriform margin, with a formal open rhinoplasty approach. Methods: All the patients underwent orthodontic treatment for preparation of the alveolar bone grafting. During the process of alveolar bone graft, a strip of septal cartilage graft was harvested from the lower border of the septum which also helps to correct the septal deviation. The cancellous bone graft harvested from the iliac crest was used to fill the alveolar gap and placed along the pyriform margin to gain symmetry. Through open rhinoplasty along the alar rim and additionally using Potter's incision extending to the lateral vestibule, the lateral crura of the alar cartilage on the cleft side was released from its lateral attachment and advanced medially as a chondromucosal flap in a V–Y fashion, in order to bring the cleft-side alar cartilage into a normal symmetric position. The harvested septal cartilage graft was used as a columellar strut. The cleft nostril sill was narrowed by a Y–V advancement at the alar base and any overhanging alar rim skin was carefully excised to achieve symmetry. Results: The results of this composite approach were encouraging in our series of 15 patients with no additional morbidity and a better symmetry of the nose and airway especially in the adolescent age group. Conclusion: This concept of simultaneous approach when appropriate for nasal correction at the time of alveolar bone grafting showed an encouraging aesthetic and functional outcome.

scholarly journals Problems In Cleft Lip Nose Patients Undergoing Augmentation Rhinoplasty With Rib Graft : A Case Report

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Nadia Kusumastuti ◽  
Gentur Sudjatmiko
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Nasal Bone ◽  
Rigid Fixation ◽  
Nasal Deformity ◽  
Cross Sectional ◽  
Alar Base ◽  
Columellar Strut ◽  
Operative Result

Correction of a cleft lip nasal deformity remains a challenging procedure in reconstructive surgery. Many different procedures have been suggested to address the problem, but few techniques have worked well and consistently. We present a case of secondary cleft nasal deformity after repair of unilateral complete cleft lip and palate on the left side. The corrective procedures carried out included closed method rhinoplasty and dorsal nasal augmentation with rib graft which was fixed to the nasal septum with needle. The patient showed satisfactory immediate post-operative result, with correction of depressed alar base and satisfying dorsal and tip projection. However, 5 months post operative result showed deviation of nasal tip to the cleft side, which we suspected was due to: warping of the rib graft, soft tissue deficiency in the cleft side which exerts pulling forces to the warping graft, and lack of rigid fixation of the graft. After appraising pitfalls encountered in augmenting nasal dorsum of cleft patients with rib graft, we concluded that some preventive measures need to be done to avoid those problems, namely: balanced cross sectional carving of rib graft, cantilever graft with plate and screw to the nasal bone, and addressing pulling force from lack of soft tissue in the cleft side by adding columellar strut graft or alar contour graft.

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