Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

Tsung-yen Hsieh; Raj Dedhia; Travis T. Tollefson

doi:10.1055/s-0038-1653986

Facial Plastic Surgery, Inhaltsverzeichnis

Facial Plast Surg 2018; 34(03): 290-297
DOI: 10.1055/s-0038-1653986

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

Tsung-yen Hsieh

¹Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, UC Davis Medical Center, Sacramento, California

,

Raj Dedhia

¹Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, UC Davis Medical Center, Sacramento, California

,

Travis T. Tollefson

¹Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, UC Davis Medical Center, Sacramento, California

› Institutsangaben

Abstract

Rhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.

Keywords

rhinoplasty - cleft lip - cleft nasal deformity - revision - cartilage graft

Volltext

Referenzen

References
1 Ishii LE, Tollefson TT, Basura GJ. , et al. Clinical practice guideline: Improving nasal form and function after rhinoplasty executive summary. Otolaryngol Head Neck Surg 2017; 156 (02) 205-219
2 Murray JC. Gene/environment causes of cleft lip and/or palate. Clin Genet 2002; 61 (04) 248-256
3 Wyszynski DF, Beaty TH, Maestri NE. Genetics of nonsyndromic oral clefts revisited. Cleft Palate Craniofac J 1996; 33 (05) 406-417
4 Tollefson TT, Shaye D, Durbin-Johnson B. , et al. Cleft lip-cleft palate in Zimbabwe: Estimating the distribution of the surgical burden of disease using geographic information systems. Laryngoscope 2015; 125 (Suppl 1): S1-S14
5 Murray JC, Schutte BC. Cleft palate: players, pathways, and pursuits. J Clin Invest 2004; 113 (12) 1676-1678
6 Chu EA, Farrag TY, Ishii LE, Byrne PJ. Threshold of visual perception of facial asymmetry in a facial paralysis model. Arch Facial Plast Surg 2011; 13 (01) 14-19
7 van Loon B, Maal TJ, Plooij JM. , et al. 3D Stereophotogrammetric assessment of pre- and postoperative volumetric changes in the cleft lip and palate nose. Int J Oral Maxillofac Surg 2010; 39 (06) 534-540
8 Foda HM. Rhinoplasty for the multiply revised nose. Am J Otolaryngol 2005; 26 (01) 28-34
9 Cuzalina A, Jung C. Rhinoplasty for the cleft lip and palate patient. Oral Maxillofac Surg Clin North Am 2016; 28 (02) 189-202
10 Blair VP. Nasal deformities associated with congenital cleft of the lip. JAMA 1925; 84: 185-187
11 McComb HK, Coghlan BA. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac J 1996; 33 (01) 23-30 , discussion 30–31
12 Huffman WC, Lierle DM. Studies on the pathologic anatomy of the unilateral harelip nose. Plast Reconstr Surg (1946) 1949; 4 (03) 225-234
13 Avery JK. The nasal capsule in cleft palate. Anat Anz 1962; 109: 722
14 Tollefson TT, Humphrey CD, Larrabee Jr WF, Adelson RT, Karimi K, Kriet JD. The spectrum of isolated congenital nasal deformities resembling the cleft lip nasal morphology. Arch Facial Plast Surg 2011; 13 (03) 152-160
15 Tollefson TT, Sykes JM. Unilateral cleft lip. In: Goudy S, Tollefson TT. , eds. Complete Cleft Care. New York, NY: Thieme; 2015
16 Coleman J, Sykes J. Cleft lip rhinoplasty. In: Papel ID. , ed. Facial Plastic and Reconstructive Surgery. 3rd ed. Stuttgart, NY: Thieme; 2009: 1082
17 Tollefson TT, Senders CW. Bilateral cleft lip. In: Goudy S, Tollefson TT. , eds. Complete Cleft Care. New York, NY: Thieme; 2015
18 Mulliken JB. Correction of the bilateral cleft lip nasal deformity: evolution of a surgical concept. Cleft Palate Craniofac J 1992; 29 (06) 540-545
19 Noordhoff MS. Bilateral cleft lip reconstruction. Plast Reconstr Surg 1986; 78 (01) 45-54
20 Stenström SJ. The alar cartilage and the nasal deformity in unilateral cleft lip. Plast Reconstr Surg 1966; 38 (03) 223-231
21 Bennun RD, Perandones C, Sepliarsky VA, Chantiri SN, Aguirre MI, Dogliotti PL. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: A 6-year follow-up. Plast Reconstr Surg 1999; 104 (03) 616-630
22 Angelos P, Wang T. Revision of the cleft lip nose. Facial Plast Surg 2012; 28 (04) 447-453
23 Cannon DE, Rhee JS. Evidence-based practice: functional rhinoplasty. Otolaryngol Clin North Am 2012; 45 (05) 1033-1043
24 Pham AM, Tollefson TT. Objective facial photograph analysis using imaging software. Facial Plast Surg Clin North Am 2010; 18 (02) 341-349
25 Posnick JC, Tompson B. Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: The bilateral cleft lip and palate deformity. J Oral Maxillofac Surg 1993; 51 (01) 2-11
26 Converse JM. Corrective surgery of the nasal tip. Laryngoscope 1957; 67 (01) 16-65
27 Crockett D, Bumstead R. Nasal airway, otologic, and audiologic problems associated with cleft lip and palate. In: Bardach J, Morris HL. , eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia, PA: WB Saunders; 1990
28 Haack J, Papel ID. Caudal septal deviation. Otolaryngol Clin North Am 2009; 42 (03) 427-436
29 Most SP. Anterior septal reconstruction: outcomes after a modified extracorporeal septoplasty technique. Arch Facial Plast Surg 2006; 8 (03) 202-207
30 Cutting C. Cleft lip nasal reconstruction. In: Rees TD, LaTrenta GS. , eds. Aesthetic Plastic Surgery. Philadelphia, PA: Saunders; 1994
31 Guyuron B. MOC-PS(SM) CME article: late cleft lip nasal deformity. Plast Reconstr Surg 2008; 121 (4, Suppl) 1-11
32 Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1999; 1 (04) 246-256 , discussion 257–258
33 Murakami CS, Barrera JE, Most SP. Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg 2009; 11 (02) 126-128
34 Tajima S, Maruyama M. Reverse-U incision for secondary repair of cleft lip nose. Plast Reconstr Surg 1977; 60 (02) 256-261
35 Tollefson TT. Apprehending otherness through wonder: A facial plastic surgeon's review of the book and movie. JAMA 2018; 319 (07) 640-642