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Surgical Pearls
Mar/Apr 2016

Definitive Cleft Rhinoplasty for Unilateral Cleft Nasal Deformity

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
JAMA Facial Plast Surg. 2016;18(2):144-145. doi:10.1001/jamafacial.2015.2031

Definitive cleft rhinoplasty is a challenging operation performed after completion of nasal growth, with the goal of long-lasting improvement in nasal symmetry and breathing.14 This procedure is intended to be the final surgery for patients with cleft lip and palate. The nasal tip and nostril asymmetries present in patients with unilateral cleft create difficulties for the definitive rhinoplasty. The typical findings contributing to these asymmetries are the retrodisplacement and underprojection of the dome, lateral slumping of the lower lateral cartilage (LLC), shortened columnella, and alar web and hooding. Herein, we present surgical pearls (Video) for performing a sliding chondrocutaneous flap, which incorporates the cleft lip incision, coupled with alar rim incision. Alar base plumping grafts are also often used. This technique can be successfully used as the primary rhinoplasty or as a revision rhinoplasty. In our practice, we perform primary rhinoplasty at the initial time of cleft repair at in patients 1 to 3 months of age and definitive rhinoplasty in teenagers, attempting to eliminate or minimize any intermediate surgical procedures to preserve available grafting material and prevent scarring. The sliding chondrocutaneous flap, or sliding cheilorhinoplasty, borrows tissue from the lip scar to improve projection of the dome and LLC position on the cleft side. The alar rim incision addresses alar and columnella hooding and creates better a contour of the nostril than a marginal incision. Both maneuvers ultimately improve nasal tip and nostril symmetry. Figure 1 shows before and after photos of a patient who underwent definitive cleft rhinoplasty with our technique.

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