Cleft Nasal Deformity in RhinoplastyDr Steve Byrd, Dallas Plastic Surgeon, describes rhinoplasty (nose jobs) for the cleft nasal deformity using rib grafts. The cleft nasal deformity is secondary to the congenital birth defect of cleft lip and cleft palate. It may affect one or both nostrils and is characterized by an underdevelopment and malposition of the lower lateral cartilages as well as loss of nasal lining and sill tissue in the nasal floor. While we currently begin correction of this defect during infancy, many adults continue to present with an inadequately corrected nose. (Want more information on cleft lip and cleft palate?)
These noses present special challenges to the rhinoplasty surgeon. Not only is the cartilage deviated and malpositioned, it seldom provides enough support to shape and project the malformed tip and nostril. Soft tissue deficiencies of the nasal lining further restrict reshaping and repositioning the nostril. Often the underlying maxilla (facial bone) is retrodisplaced further lessening the support to the nose (middle case and case to right). Standard rhinoplasty techniques will simply not work with this deformity. If the facial bones are retrodisplaced, they need to be repositioned before or at the time of rhinoplasty. Ear and septal cartilage grafts are by themselves inadequate to both support and reshape the nose. I use rib cartilage grafts from the free floating 10th and 11th ribs to support the tip. Septal cartilage is used to shape and support the nostril.
Byrd HS, Salomon J: Primary correction of the unilateral cleft nasal deformity. Plast Reconstr Surg 2000 Nov 106(6);1276-86. Burt JD, Byrd HS: Cleft lip: unilateral primary deformities. Plast Reconstr Surg 2000 Mar 105(3):1043-55; quiz 1056-7 |
