The nose being the most visible organ contributes enormously to facial aesthetics. Cleft Lip Nasal Deformity is a complex deformity that involves skin, cartilage, mucosa as well as skeletal platform. This condition tends to aggravate with the growth of the child if not dealt with surgically. Though a cleft nose grows as the patient ages, it still remains 30% smaller than those without a cleft lip deformity. Such distorted anatomy could impair nasal airflow and alsohave social & psychological implications and hence it is always better to get this surgically corrected at a young age.
Cleft Lip Nasal Deformity is a common birth defect with varying degrees of nasal deformity grading from mild to severe inadequate function, shape and appearance of the nose. A variety of time-honoured techniques of Rhinoplasty have been applied in the correction of Cleft Lip Nasal Deformity to achieve symmetry, aesthetic balance, and functional correction of the nose. Patients with cleft lip nasal deformity pose a great challenge in Rhinoplasty as the biggest issue is to achieve caudal nose harmony and creation of symmetrical nostrils with normal nasal function.
Surgery is most often the best option to correct Cleft Lip Nasal Deformity due to factors like difficult nasal breathing and altered nasal function coupled with the tendency for chronic rhinosinusitis and the aesthetic look of the nose, both of which may affect the patient’s quality of life negatively and can cause heavy psycho-social burden for them.Most correction techniques of Cleft Lip Nasal Deformity involve a dissection of the skin overlying the lower lateral cartilages through both medial and lateral tunnels within the cleft lip incisions. Some surgeons perform limited nasal dissection for the fear of growth retardation, whereas others opt for full cartilage correction at the time of primary surgery itself.
There are various materials that can be used to augment nasal dorsum during the correction of Cleft Lip Nasal Deformity. Augmentation of dorsum of the nose can be achieved using alloplastic materials, bone, or cartilage. Although various types of alloplastic materials have been used for dorsal augmentation, they are hampered with long-term complications that make them unattractive for long-term cleft lip nasal deformity correction. Bone graft is also another viable option for correction of the deformity.
Surgical correction of Cleft Lip Nasal Deformity should ideally be performed before the first year of age, usually between 3 and 6 months-of-age, prior to speech development. Some surgeons though prefer the cartilages to grow and mature before going in for surgery. With peer pressure becoming an important consideration during the teens, the current trend is towards early correction. The aim of the operation is to reunite all tissue layers of the lip, to reposition the nasal septum and to separate the oral and nasal cavities; and restore the valve function of the soft palate. Early correction of the nasal deformity would assure a more normal relationship of the columella-lip angle, better projection and definition of the tip, and also allow subsequent growth in a more normal anatomic relationship.
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