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Secondary Cleft Lip Rhinoplasty
30 July 2002 (online)
Without any doubt, rhinoplasty in adults or adolescent patients born with clefts of the lip, combined with clefts of alveolus and palate, is most challenging. In unilateral clefts, the asymmetry of the nasal base is the most striking aesthetic feature. The surgeon is confronted with scars, deformed and displaced cartilages, and abnormal soft tissues, which sometimes seem to resist all attempts to move and hold them in the desired position. Residual or recurrent asymmetries are often attributed to this ``memory-effect.'' The technical procedures to overcome this tendency and correct the nasal deformity are numerous and it is difficult to evaluate their effectiveness.
Contributors to this issue of Facial Plastic Surgery are ENT specialists and a maxillofacial surgeon. Maxillofacial surgeons are usually the first who operate on a child born with a cleft lip. One can assume that the deformity visible in adolescents and adults is the result of the malformation, surgical interventions, and growth disturbances. So we must respect embryology and techniques to repair the cleft lip in order to understand the resulting deformity. The effectiveness of surgical procedures can be better estimated using a thorough knowledge of the surgical anatomy present in cleft patients.