Unilateral cleft lip-nose repair: a 33-year experience

A 33-year experience with a proven method of repair for primary unilateral cleft lip-nose is presented. The technique used by the authors has been improved by modifications that have led to better symmetry and balance with less scarring. The technique involves ignoring the abnormal skeletal base, use of perisurgical passive orthopedics, and primary surgical correction of the nose and lip. Improved results can consistently be achieved by approaching the nose laterally through an inferior turbinate incision, freeing completely the lip and nose components so they can be translocated to match the normal side. Accurate positioning and symmetry of the alar base and sill is aided by limiting the transverse incision in the lip. This results in less scarring and improved sill reconstruction. The technique for floor-of-the-nose reconstruction avoids a small nostril without discarding any tissue. It is important to leave tissue in the floor to compensate for the skeletal deficiency. The senior author has performed this procedure in more than 750 patients. Approximately 35% have or will require minor secondary reconstruction at age 5 years. An aesthetic rhinoplasty is performed on most patients after growth is complete. Self-esteem is enhanced by early nasal reconstruction and has become the authors' standard of care for rehabilitation of the unilateral cleft lip and palate. Many surgeons remain reluctant to perform primary nasal repair. With careful proper technique, any experienced cleft surgeon can learn this procedure. For the beginner, conservatism is recommended.