[A personal rhinoplasty concept for patients with cleft lip, jaw, palate]

In the treatment of patients with cheilognathouranoschisis, rhinoplasty is a great challenge, since the cleft lip and palate will also produce nasal deformation requiring surgical correction. Unilateral cleft lip and palate is usually associated with a pronounced septal deformity resulting in "crooked nose" as well as typical asymmetry of the apex of the nose and of the nasal vestibule. The anterior part of the septum is dislocated in the direction of the unaffected side and the lower border of the septum is at the same time subluxated to the opposite side. The dorsal part of the septum presents with a convex deformity towards the cleft side extending in horizontal and vertical direction. Severe septal deformities cannot usually be adequately corrected on the spot, i.e. loco, but since septal correction is of paramount importance for the appearance and functioning of the nose we performed an extracorporeal correction of the septum in 191 cleft patients during the period from January 1980 through May 1993. Another characteristic feature of the cleft nose is the oblique modiolus, or columella cochleae, which is shortened on the cleft side, and the S-shaped deformity of the lateral alar cartilage, which presents with a cranial dislocation in the dome, caudal deviation in the lateral part, and an overhanging ala. After correction of the entire cartilaginous nasal framework the surgeon is usually confronted with asymmetry of the soft tissue. Satisfactory correction can be achieved by means of a three-flap technique in the region of the modiolus, nasal ala and vestibular skin: A modiolus-based transpositional flap results in a symmetrical height of the modiolus.(ABSTRACT TRUNCATED AT 250 WORDS)