The Aesthetic Secondary Rhinoplasty Following Nasal Reconstruction with the Primary Cleft Lip Repair
Nicholas T. Haddock, Mark McRae, MD, Court Cutting, MD.
NYU Medical Center, New York, NY, USA.
BACKGROUND:The senior author routinely performs primary nasal reconstruction with each cleft lip repair. With adequate dissection and release of the alar cartilages much of the traditional cleft lip nasal deformity can be corrected. When these patients present for secondary rhinoplasty they can be approached with principles similar to what would be used in an aesthetic rhinoplasty.
METHODS:A retrospective chart review was completed of all secondary rhinoplasties performed in patients with previously repaired cleft lips. A primary nasal reconstruction is performed with both unilateral and bilateral cleft lip repairs performed by the senior author. In review the indications for secondary rhinoplasty were examined, the anatomical features of the nose at the time of operation were documented and the required type of reconstruction was recorded.
RESULTS:From 2001 to 2009 the senior author performed 215 secondary rhinoplasties in patients with a previously repaired cleft lip. The senior author performed 58 of the initial cleft lip repairs. In this patient population the Average age was 17. It was noted that the domes were depressed in 52.5%, the alar base was lateralized in 60.0% and a vestibular web was present in 41% patients. A Dibbell rhinoplasty was performed in 20.0%, a Potter rhinoplasty was performed in 2.5%, a Tajima inverted U incision was performed 65.8% and an alar base resection was performed in 56.4%. One representative case will be presented. For those patients that did not undergo cleft lip repair with primary rhinoplasty by the senior author the domes were depressed in 80.9%, the alar base was lateralized in 63.6% and a vestibular web was present in 14.7% patients. A Dibbell rhinoplasty was performed in 50.7%, a Potter rhinoplasty was performed in 1.4%, a Tajima inverted U incision was performed 67.1% and an alar base resection was performed in 60.9%.
CONCLUSIONS:The technique including primary nasal reconstruction with cleft lip repair has produced consistent results. At secondary rhinoplasty the lower lateral cartilages are more symmetrical and much more appropriately aligned. This allows for the secondary rhinoplasty to be performed using principles more inline with standard aesthetic rhinoplasties.
Back to Program