Children born with cleft lips and cleft palates generally have associated defects of the nose as well. The so called “cleft nose” is often very asymmetric with smaller, weaker, and misshapen cartilages on one or both sides. The septum generally has a significant deviation or deflection and the inner lining of the nose on the affected side if it is a one-sided cleft is also deficient and thus tight. In addition, to the nasal abnormalities the facial bones surrounding the nose usually are misshapen, deficient, and asymmetric. The combination of all of these factors creates an abnormal nose with very complex and interwoven causes. The surgical approach to cleft noses must address each one of these problems, often including the correcting the issues associated with surrounding facial element, in order to bring about a synergistic and comprehensive solution.
Many patients who have a nose affected by cleft lip/cleft palate have had prior nasal surgery when they were younger, sometimes even as infants. However, when we speak of cleft rhinoplasty we generally are referring to the definitive nasal surgery that occurs when a patient is a teenager or an adult. The goal of the cleft rhinoplasty is to address both the cosmetic and functional (breathing) problems. In cleft patients it is wise to consider this a process in that at times more than one operation can be required to obtain the desired results. That is to say that some patients require adjunctive procedures prior to the formal rhinoplasty or during the final rhinoplasty in order to correct the facial base issues and the nasal lining challenges that make cleft rhinoplasty a complex endeavor. Specifically bony or cartilage grafts can be required to build up the portion of the face that serves as the base supporting the nose and skin or skin-cartilage composite grafts can be required to address some of the lining limitations. The formal rhinoplasty in my opinion requires an open rhinoplasty. In this procedure the septum is straightened which facilitates improved straightening of the nose in general. The tip shape is made more normal and the symmetry of the sides of the nose (ala) is improved. These maneuvers require cartilage grafts. Sometimes the septum provides sufficient cartilage for this purpose but often cartilage is required from the ribs and/or ears.
- On staff at children hospital with cleft center/Significant experience with cleft nasal surgery
- Utilizes patients own tissues to re-build the nose
- Additional advanced fellowship training in rhinoplasty
- Published scientific contributions regarding rhinoplasty technique improvement
- Speaking engagements on nasal surgery at major scientific meetings and a nationally ranked medical schools
Cleft rhinoplasty generally requires general anesthesia but is usually performed on an outpatient basis. A small splint is applied on the outside of the nose. Often soft plastic splints are placed inside the nostrils. Packing is not routinely used. The splints, both internal and external, are removed at about one week. Bruising and swelling is generally mild and lasts about 7 days. Patients generally return to school or work at about that time. A mild amount of discomfort will be felt at the ear if cartilage is borrowed from that location. Generally no change in the shape of the ear is noted. If cartilage is borrowed from the ribs there will be some mild soreness on the chest as well.