The Nasal Base in Cleft Lip Rhinoplasty

Gerhard Rettinger; Michael O'Connell

doi:10.1055/s-2002-33063

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2002; 18(3): 165-178
DOI: 10.1055/s-2002-33063

The Nasal Base in Cleft Lip Rhinoplasty

Gerhard Rettinger¹ , Michael O'Connell²

¹University Clinic for Otorhinolaryngology, Ulm, Germany
²Department of Otorhinolaryngology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom

Abstract

ABSTRACT

The discussion on how to correct the nasal base in cleft lip (CL) rhinoplasty focuses on timing of the surgery, the type of approach, and the technique of repositioning the ala. Little attention is paid to the nasal vestibule. We compared the results of two different techniques. Forty-two patients were operated on via an endonasal approach with total mobilization of the lateral crus and fixation after repositioning. An external approach was used in 12 patients and the lateral crus freed as a medially based chondrocutaneous flap. The defect in the lateral vestibule wall was covered with an ear composite graft. The latter group showed more stable results concerning symmetry and breathing. We conclude that in most cases of unilateral CL noses there is not only a malposition and deformity of soft tissues and skin of the ala, but also a deficiency in the surface of inner lining of the nasal vestibule that needs appropriate repair. In general, the numerous procedures for repair of the nasal base in unilateral CL patients can be attributed to three principles based on different philosophies concerning the underlying pathology.

KEYWORDS

Unilateral cleft lip nose - secondary repair - surgical anatomy - surgical principles

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1 *The terminology of the nasal cartilages is somewhat different from the standard terms ``lower and upper lateral cartilages'' as we feel that these are not anatomically correct.