Functional and aesthetic nasal reconstruction in unilateral CLP-deformity

The correction of nasal deformities in cleft patients presents a challenge in the secondary treatment of this malformation. The complexity of the nasal deformity in cleft patients partly depends on the congenital anomaly itself and partly on the surgical procedures which were previously carried out. The nasal deformities in unilateral CLP patients are typical. The nasal floor and the nostril sill are mainly constructed during primary lip repair. While the ala on the cleft side is repositioned, the septum deformity and the anterior spine dislocation are not touched. If large circular incisions are used at the time of primary operation to achieve symmetry, the situation usually deteriorates. One of the main characteristics of a classic cleft lip nose is the deviation of the external nose to the non-cleft side due to the typical septal deformity, where the anterior part of the septum and the caudal edge of the septum are subluxated to the non-cleft side (Fig. 1). Furthermore, there is a typical asymmetry of the nasal tip and the ala (Figs. 5 to 7). The columella is slanted and shortened on the cleft side. The ala cartilage on the cleft side is distorted and displaced. There are two important points in the concept of surgical rehabilitation: First, straightening the deviated nose, which often needs extracorporeal septum correction. This seems to be the prerequisite for correction of the external deviation. Second, rehabilitation includes the correction of the asymmetry of the tip and the nostril. A number of techniques have been suggested for this problem, which indicates that there is no ideal procedure. In our hands the triple-flap repair produced good and reliable results. There was no difference in the results, whether an open approach or an endonasal one was used.