Rhinoplasty, despite the relatively small size of the nose, the challenge remains the operation. intricacies nasal bones and cartilage anatomy and that each requires a real three-dimensional appreciation of what happens when these relationships change surgery. When it comes to congenital nasal deformities such as cleft lip and palate, and rhinoplasty challenges become magnified as abnormal and deformed anatomy is covered in the process.
Nose deformity caused by oral clefting is a highly variable and influenced by the severity of the underlying problem of cleft. Facial clefts present in widely different forms of incomplete microform cleft lip with severe bilateral cleft lip and palate. In any case, the overlying anatomy of the nose is affected by the distortions and tissue defects. Even in relatively simple unilateral cleft lip and palate, and the alar cartilage overlying skin is not malpositioned only, but in a short matter. Bilateral cleft lip and palate patient has a severe lack of columellar skin, which is the limiting factor of ever getting a big tip of the nose result.
Rhinoplasty in the cleft of adult patients does not differ from younger patients. Almost always, the nose through numerous surgeries, the scars, and recognizeable nasal anatomy difficult to find. patient usually has a lifelong difficulty with breathing, although well suited at this point in his life. Such a nose defies any simple or standard rhinoplasty approach.
In my experience, adult cleft nose patients generally presented as two types. Those who have had a number of rhinoplasties since childhood, had a significant improvement in both appearance and function, and are looking to get the best final result. Or a very challenging cases, that, despite previous surgery or lack thereof, is a nasal "disabled" with a heavy external distortion and significant airway obstruction.
I think the majority of adult cleft rhinoplasties should be approached with the concept of total or near the nose reconstruction. One must be willing to take a larger part of the nose, but i almost start form the beginning. It is important to separate anatomy and start rebuilding the frame, rather than trying to tweak or patch the existing anatomy in some cases.
Cartilage grafts are always needed and a good straight pieces are popular and useful. This is rarely a problem that too much cartilage has been used or have too many. I think synthetic implants are rarely suitable for this type of rhinoplasty and likely to lead to some complications related to plant down the road. As a result, the rib graft harvest can meet those needs best and should enter the process with the first step. Do not let the boys supply dictate that the operation will be performed, because it is a variable that can be controlled and predicted. In some cases, the cartilage tip modifications may be needed. But the increase in dorsal, middle vault reconstruction spreader grafts, columellar struts, lower Alar batten grafting, rib cartilage allows any and all of which are performed without any restrictions.