Primary Rhinoplasty in Unilateral Cleft Lip | Journal CME Article-Journal CME Article: Primary Rhinoplasty in Unilateral Cleft Lip

Journal CME Article: Primary Rhinoplasty in Unilateral Cleft Lip

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This comprehensive article addresses the complex challenges of primary rhinoplasty performed concurrently with unilateral cleft lip repair in infants. It emphasizes the critical understanding of embryologic nasal development and anatomical distortions caused by cleft lip deformities. The cleft lip nasal deformity involves intrinsic maxillary hypoplasia, malpositioned lower lateral cartilage (LLC) trapped in distorted soft tissues, caudal septal deviation, lateralized alar base, and loss of normal nasal contours and symmetry.<br /><br />Historically, concerns about potential growth restriction delayed nasal intervention during primary cleft lip repair. However, increasing evidence supports primary cleft rhinoplasty to improve functional, aesthetic, and psychological outcomes during early childhood, minimizing more challenging future corrections. Surgical goals include straightening the nose, centralizing the columella, repositioning the alar base symmetrically, closing the nasal floor, and achieving symmetric tip projection and nostril contour.<br /><br />The article reviews key reconstructive principles: limited septoplasty to reposition the deviated caudal septum, alar base release and repositioning to the piriform aperture, nasal floor closure, correction of distorted scroll region and vestibular webbing, and nasal tip manipulation. Approaches to nasal tip correction vary widely, encompassing conservative (minimal tip dissection), closed (tip reshaping through lip incisions), and open techniques (direct cartilage exposure via rim or Tajima reverse U-rim incisions). Each has advantages and drawbacks concerning exposure, scarring, and long-term outcome. Notably, open approaches facilitate more aggressive correction but raise concerns about tip scarring and nostril stenosis.<br /><br />Postoperative management including dead space obliteration with quilting sutures and prolonged nasal stenting is important to maintain graft and cartilage positions and improve nasal symmetry. The article highlights ongoing controversies about technique extent and timing, balanced by surgeon judgment and patient-specific factors.<br /><br />Ultimately, primary cleft rhinoplasty demands meticulous three-dimensional analysis, individualized surgical planning, and a commitment to long-term outcome documentation. While no universal consensus on best practice exists, evolving strategies emphasize early nasal correction integrated with lip repair to optimize aesthetic and functional results, minimize psychological impact, and reduce the need for secondary procedures.

Keywords

primary rhinoplasty

unilateral cleft lip repair

embryologic nasal development

cleft lip nasal deformity

maxillary hypoplasia

lower lateral cartilage malposition

caudal septal deviation

nasal floor closure

nasal tip correction techniques

postoperative nasal stenting