International Journal of Head and Neck Surgery

Register      Login

VOLUME 11 , ISSUE 2 ( April-June, 2020 ) > List of Articles

REVIEW ARTICLE

Secondary Rhinoplasty on Patients with Cleft Lip and Palate: A Review

Vijayaranghan Sathyabama, Muthusubramanian Veerabahu

Keywords : Augmentation grafts, Cleft lip and palate, Columella lengthening, Rhinoplasty, Secondary rhinoplasty, Steal technique, Strut graft

Citation Information : Sathyabama V, Veerabahu M. Secondary Rhinoplasty on Patients with Cleft Lip and Palate: A Review. Int J Head Neck Surg 2020; 11 (2):26-31.

DOI: 10.5005/jp-journals-10001-1386

License: CC BY-NC 4.0

Published Online: 01-04-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: The cleft lip and palate patients undergo a series of surgical procedures from the time of their birth, wherein the primary cleft lip correction procedure is carried out. The last in the series is rhinoplasty after the maxillary skeletal base has been set right in its dynamics with the mandibular base. The degree of deformity lies in the type of cleft and its accompanying features. The timing of correction at the primary lip closure stage, allowing a repositioning of the lateral nares, the detailed examination of the nose at the time of presentation ascertains the degree of augmentation necessary. Background: The first mention of rhinoplasty dates back to the dates of Shusruta and his disciples who managed to reconstruct parts of the nose and ear, which were sliced as a part of criminal punishment. The Roman encyclopedist published the techniques of reconstruction, followed by the Europeans. By the 11th century, the Arabs converted Shushruta's book into Sanskrit, and this spread to the Western atmosphere. Evidence for a free flap graft and a forehead graft that were adopted and published by Doctors Cruzo and Findlay in 1794 are the first steps to the modern rhinoplasty techniques. Review results: The correction of the nose at the primary surgery of the cleft lip was widely accepted to reduce the gross deformities that would manifest if the small corrections were not made appropriately the first time. The caudal resection of septae was identified as the reason for the growth deformities that happened secondarily. The secondary rhinoplasty was to be performed as a final procedure after the growth phase when all other surgical procedures were done and dealt with leaving an L-shaped strut of the septae at the dorsal, and the caudal end was advocated for a stable result of the septum without any buckling and further deformity. Conclusion: The key to performing a near-perfect procedure lies in the clinical assessment at the time of presurgical presentation.


HTML PDF Share
  1. Gary C, Sykes J. Intermediate and definitive Cleft Rhinoplasty. Facial Plast Surg Clin North Am 2016;24:487–494. DOI: 10.1016/j.fsc.2016.06.017.
  2. Millard JR. Cleft Craft: Bilateral and Late Deformities, 1st ed., Boston, Mass: Little, Brown; 1976.
  3. McComb HK, Coghlan B. Primary repair of the Unilateral Cleft lip and Nose, Completion of a Longitudinal Study. Cleft Palate Craniofac J 1996 Jan;33(1):23–30. DOI: 10.1597/1545-1569_1996_033_0023_protuc_2.3.co_2.
  4. Jonnalagadda A, Jami S, Pydi KL. Cleft Lip Rhinoplasty. Sci J Clin Med 2016;5(4-1):20–26.
  5. Cohen M, Morris DE, White AD, et al. Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities. Indian J Plast Surg 2009 Oct;42(Suppl):S91–S101. DOI: 10.4103/0970-0358.57195.
  6. Cuzalina A, Jung C. Rhinoplasty for the Cleft Lip & Palate patient. Oral Maxillofac Surg Clin North Am 2016 May;28(2):189–202. DOI: 10.1016/j.coms.2015.12.002.
  7. Haddock NT, McRae MH, Cutting CB. Long term effect of primary cleft rhinoplasty on secondary cleft rhinoplasty in patients with unilateral cleft lip – cleft palate. Plast Reconstr Surg 2012;129(3):740–748. DOI: 10.1097/PRS.0b013e3182402e8e.
  8. Sykes JM, Jang YJ. Cleft Lip Rhinoplasty. Facial Plast Surg Clin North Am 2009 Feb;17(1):133–144. DOI: 10.1016/j.fsc.2008.10.002.
  9. Bhattacharya S, Khanna V, Kohli R. Cleft Lip: The historical perspective. Indian J Plast Surg 2009 Oct;42(Suppl):S4–S8. DOI: 10.4103/0970-0358.57180.
  10. Van Beek AL, Hatfield AS. Ellie Shpnef: Cleft Rhinoplasty. American Society of Plastic Surgeons; 2004.
  11. McComb H. Primary correction of Cleft lip and nasal deformity. A 10 year review. Plast Reconstr Surg 1985 June;75(6):791–799. DOI: 10.1097/00006534-198506000-00003.
  12. Blair VP. Nasal deformities associated with congenital cleft of the lip. JAMA 1925;84:185–187.
  13. Hellings PW, Hens G, Shoenaers J, et al. Unique approach to secondary cleft lip rhinoplasty in facial plastic surgery. B-ENT 2010;6(Suppl 15):97–101.
  14. Salyer KE. Early and late treatment of Unilateral cleft nasal deformity. Cleft Palate Craniofac J 1992 Nov;29(6):556–569. DOI: 10.1597/1545-1569_1992_029_0556_ealtou_2.3.co_2.
  15. Trott JA, Mohan N. A preliminary report on open tip rhinoplasty at the time of lip repair in unilateral cleft lip and palate: The Alor Setar experience. Br J Plast Surg 1993 Jul;46(5):363–370. DOI: 10.1016/0007-1226(93)90040-i.
  16. Mulliken JB. Primary repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg 2001 Jul;108(1):181–194. DOI: 10.1097/00006534-200107000-00028.
  17. Capone R, Sykes J. Evaluation and management of Cleft Lip and Palate disorders. Facial Plastics and Reconstructive surgery. NY: Thieme; 2009. pp. 1059–1060.
  18. Khan HA. Rhinoplasty: Initial Consultation and Examination. Oral Maxillofac Surg Clin North Am 2012 Feb;24(1):11–24. DOI: 10.1016/j.coms.2011.11.002.
  19. Bohluli B, Moharamnejad N, Yamini A. Nasal base surgery. Oral Maxillofac Surg Clin North Am 2012 Feb;24(1):87–94. DOI: 10.1016/j.coms.2011.10.009.
  20. Ghavami A, Janis JE, Acikel C, et al. Tip shaping in Primary Rhinoplasty: An algorithmic approach. Plast Reconstr Surg 2008 Oct;122(4): 1229–1241. DOI: 10.1097/PRS.0b013e31817d5f7d.
  21. Parrilla C, Artuso A, Gallus R, et al. The Role of Septal surgery in cosmetic Rhinoplasty. Acta Otorhinolaryngol Ital 2013 Jun;33(3): 146–153.
  22. Nease CJ, Deal RC. Septoplasty in conjunction with Cosmetic Rhinoplasty. Oral Maxillofac Surg Clin North Am 2012 Feb;24(1):49–58. DOI: 10.1016/j.coms.2011.10.006.
  23. Kaufman Y, Buchanan EP, Wolfsinkel, EM, et al. Cleft nasal deformity and Rhinoplasty. Semin Plast Surg 2012 Nov;26(4):184–190. DOI: 10.1055/s-0033-1333886.
  24. Bagheri SC. Primary Cosmetic Rhinoplasty. Oral Maxillofac Surg Clin North Am 2012 Feb;24(1):39–48. DOI: 10.1016/j.coms.2011. 10.001.
  25. Ralph Jr DR. Columella lengthening by a forked flap. Plast Reconstr Surg Transplant Bull 1958 Nov;22(5):454–457.
  26. Takato T, Yonehara Y, Susami T. Columella lengthening using a cartilage graft in the bilateral cleft lip-associated nose: choice of cartilage according to age. J Oral Maxillofac Surg 1995 Feb;53(2): 149–157. DOI: 10.1016/0278-2391(95)90393-3.
  27. Koehler J, Mclain L. Grafting in Cosmetic Rhinoplasty. Oral Maxillofac Surg Clin North Am 2012 Feb;24(1):59–66. DOI: 10.1016/j.coms.2011.10.010.
  28. Narayanan V, Adenwalla HS. Primary Rhinoplasty at the time of unilateral cleft lip repair: A review and our protocol. Puthucode J Cleft Lip Palate Craniofac Anomal 2015;2:92–97.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.