Cleft lip nasal deformities are challenging problems in all aspects and there are debates about timing, approaches, techniques as well as types of the used grafts.
The current study tried to explore the different surgical options for reconstruction of the nasal tip in cases of secondary cleft lip nasal deformity, evaluate of their esthetic and functional results and demonstrate the subjective satisfaction for each case.
In this study, 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 evaluation of the net aesthetic result. All patients with previous nasal bone fracture or primary cases of cleft nasal deformity under the age of 12 years old were excluded.
The post-operative results were evaluated concerning subjective satisfaction, objective assessment of the nasal tip, development of secondary deformities or complication and finally regarding the improvement of the recorded pre-operative functional complaints.
The results of this study showed that:
A debate is going on whether to attempt immediate manipulation of alar cartilage to correct the deformity or to postpone the management until full growth of the nose.
The corner stone for achieving the best aesthetic outcome is total nasal reconstruction via external rhinoplasty technique.
The vast majority of the operated patients had an obvious degree of satisfaction after 6 months of post-operative follow up.
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Use of autologous cartilaginous grafts is considered an excellent source of supporting nasal grafts with no recorded intra- or post-operative donor site morbidity.
The costal cartilage is the most preferable and suitable source of cartilaginous grafts as it can achieve the most superior results.
Use of different types of nasal grafts is mandatory in all cases of cleft lip nasal deformity.
The post-operative complications and deformities could occur even after meticulous surgical technique. So, all post-operative sequels, possibilities and expectations should be discussed frankly in details with the patient pre-operatively.
Rhinoplasty for cleft lip nasal deformity improved some of the pre-operative functional symptoms, the sense of difficult breathing. But failed to improve the abnormal voice tone.
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Conclusion
A naturally looking nasal tip projection not only determines the patients‟ degree of satisfaction but also is considered the ultimate aesthetic as well as functional goal for the surgeons.
Tip rhinoplasty in cases of cleft lip nasal deformity is a complex procedure. As in the current study, 105 surgical options (either sutures or grafts) in addition to the secondary procedures were used in the operated 25 patients aiming to achieve the desired post-operative results.
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. |
