Primary rhinoplasty by open approach with repair of unilateral complete cleft lip

Nasal deformities inherent to a cleft are challenging. Controversy was existing regarding the best time to correct these nasal problems. Now, there is consensus that these nasal deformities are better to be dealt with along with the repair of the cleft lip.Primary cheilorhinoplasty involves proper reconstruction of the clefted musculoapeneurotic complex by placing the muscles in their proper anatomic-physiologic orientation through careful identification, dissection, and mobilization of the paranasal and the labial musculatures. In short, the cleft repair is a muscle repair, and this enhances the establishment of a normal nasolabial complex. Delicate dissection and accurate repositioning of the lower alar cartilages during the primary lip repair will definitely help to establish a normal nasal shape. The nasal tissues must be supported with accurately placed sutures either by an open or by a closed approach. The author prefers the open approach technique as published by Trott and Mohan, with modifications, because it has the added advantage for the identification and proper repositioning of the lower alar cartilages by accurately placed sutures under direct vision, and the incisions of this procedure can be carried out through the hidden rim incisions without any residual scars even in the black population who were offered this technique. Silicone nostril retainers, if available, during the immediate postoperative period will definitely promote the proper contours and the patency of the nostrils.Since 1994, the author has been using this technique for patients with complete unilateral and bilateral cleft lips, which are presented separately. Patients with incomplete cleft lip are not included in this study because the nasal deformities are minimal, although the technique can also be adopted for correction of incomplete cleft lip nasal deformity. Until December 2007, a total of 255 children with complete unilateral cleft lip with gross nasal deformities have been operated on and followed up with.