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Surgical Pearls |

Definitive Cleft Rhinoplasty for Unilateral Cleft Nasal Deformity

Myriam Loyo, MD1; Tom D. Wang, MD1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
JAMA Facial Plast Surg. 2016;18(2):144-145. doi:10.1001/jamafacial.2015.2031.
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This surgical technique describes cleft rhinoplasty for long-lasting nasal symmetry and breathing improvement.

Definitive cleft rhinoplasty is a challenging operation performed after completion of nasal growth, with the goal of long-lasting improvement in nasal symmetry and breathing.14 This procedure is intended to be the final surgery for patients with cleft lip and palate. The nasal tip and nostril asymmetries present in patients with unilateral cleft create difficulties for the definitive rhinoplasty. The typical findings contributing to these asymmetries are the retrodisplacement and underprojection of the dome, lateral slumping of the lower lateral cartilage (LLC), shortened columnella, and alar web and hooding. Herein, we present surgical pearls (Video) for performing a sliding chondrocutaneous flap, which incorporates the cleft lip incision, coupled with alar rim incision. Alar base plumping grafts are also often used. This technique can be successfully used as the primary rhinoplasty or as a revision rhinoplasty. In our practice, we perform primary rhinoplasty at the initial time of cleft repair at in patients 1 to 3 months of age and definitive rhinoplasty in teenagers, attempting to eliminate or minimize any intermediate surgical procedures to preserve available grafting material and prevent scarring. The sliding chondrocutaneous flap, or sliding cheilorhinoplasty, borrows tissue from the lip scar to improve projection of the dome and LLC position on the cleft side. The alar rim incision addresses alar and columnella hooding and creates better a contour of the nostril than a marginal incision. Both maneuvers ultimately improve nasal tip and nostril symmetry. Figure 1 shows before and after photos of a patient who underwent definitive cleft rhinoplasty with our technique.

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Figure 1.
Preoperative and Postoperative Photographs for Definitive Cleft Rhinoplasty

A sliding chondrocutaneous flap, an alar rim incision, and the plumping graft for the alar base were used.

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Figure 2.
Lip Scar Excision and the Chondrocutaneous Flap
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Intraoperative video of definitive rhinoplasty for the unilateral cleft defect. A sliding chondrocutaneous flap, an alar rim incision, and the plumping graft for the alar base were used.

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