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. |
