Facial Plast Surg 2002; 18(3): 155-164
DOI: 10.1055/s-2002-33062
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Lip Repair Techniques and Their Influence on the Nose

Mostafa Farmand
  • Clinic of Oral and Maxillofacial Surgery, Plastic Operations, Clinic Sud, Nürnberg, Germany
Further Information

Publication History

Publication Date:
30 July 2002 (online)

ABSTRACT

The cleft nose has long been a problem when closing the lip in a cleft palate patient. More today than in the past, close attention is paid to the outcome of the nasal form, nasal base, and the position of distorted structures like the alar cartilage and the septum.

The different techniques of lip closure can be used simultaneously with the nasal correction. But different methods of lip repair without primary nasal correction also influence the nasal form. It seems that the reconstruction of the nasolabial muscles (including the orbicularis muscle) is an important factor to gain a symmetrical nose after the primary operation. Although the results are very promising, it cannot be stated that no further operations will be needed later. But since growth disturbance has not been reported until now, most of the authors dealing with primary nasal correction recommend it simultaneously with the lip repair.

Further investigations are needed to define the outcome after the cessation of growth.

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