Tip Rhinoplasty in Cleft Lip Nasal Deformity
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Introduction: The cleft nasal deformity is a complex challenge in plastic surgery involving the skin, cartilage, mucosa, and skeletal platform. The appropriate approach has been extensively debated in the literature with respect to timing, technique, and extent of surgical intervention. Aim: The aim of current work is to study the different surgical options for reconstruction of the nasal tip in cases of secondary cleft lip nasal deformity, to evaluate their esthetic and functional results and demonstrating the subjective satisfaction for each case. Patients and Methods: Twenty five patients having cleft lip nasal deformity underwent rhinoplasty to correct the nasal deformity in which the definition and position of the nasal tip were the corner stones in evaluating the net aesthetic result. All study patients underwent tip rhinoplasty in the form of suturing as well as grafting. They underwent some secondary procedures like, pyriform aperture augmentation, dorsum correction, alar rim and web correction, air way patency, and corrective osteotomies. Results: Subjective evaluation results of current study were generally promising; 44% of patients were happy of their nasal job, 48% showed fair response, while 8% were unhappy. Most of happy patients were males, they obtained their cartilage grafts from the costal cartilage. The objective judgement of the rhinoplasties done in the study showed that 80% of patients had accepted net nasal tip while 20% had residual deformity in the form of wide, bulky, or deviated tip. The residual tip deformity came mainly after use of auricular graft, after using tip suturing and diced cartilage on top. Postoperative secondary deformities were few in the form of asymmetrical nose, obtuse naso-facial angle, alar web, or unpleasant lip scar. All patients that had an obstructed airway before the operation had improved, while 30% of those who had nasal tone showed improvement after the operation. Conclusion: Nasal grafts are essential for considerable good outcomes for cases of cleft nasal deformity. Autologous cartilaginous grafts are the most suitable type of nasal grafts, and costal cartilage graft is the most superior between them. Further studies are needed to justice if primary rhinoplasty is beneficial or it disturbs the nasal symmetry and leave scared tissues for a potential future intervention.