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

Nasal deformities inherent to a cleft are challenging. A controversy existed regarding the best time to correct these nasal problems. Now, there is a consensus that these nasal deformities are better to be dealt with along with repair of cleft lip.Primary cheilorhinoplasty involves proper reconstruction of clefted musculoaponeurotic complex by placing the muscles in their proper anatomic-physiologic orientation through careful identification, dissection, and mobilization of paranasal and labial musculature. In short, cleft repair is a muscle repair that enhances the establishment of a normal nasolabial complex. Delicate dissection and accurate repositioning of the lower alar cartilages during a 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 a closed approach. The author prefers the open approach as published by Trott and Mohan (Br J Plast Surg 1993;46:215-222) 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 hidden rim incisions without any residual scars even in the colored population who were offered with 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 performing this technique for patients with complete unilateral and bilateral cleft lip, which were presented separately. Patients with incomplete cleft lip were not included in this study because the nasal deformities were minimal, although the technique can be adopted for the correction of incomplete cleft lip nasal deformity also. Till December 2007, a total of 142 children with complete bilateral cleft lip with gross nasal deformities have been operated on and followed up.