eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Unilateral Cleft Nasal Repair: Workup

Author: Mimi T Chao, MD, Consulting Surgeon, Pediatric Plastic Surgery, Children's Hospital Central California
Coauthor(s): Joseph E Losee, MD, FAAP, FACS, Chief, Division of Pediatric Plastic Surgery, The Children's Hospital of Pittsburgh; Director, Pittsburgh Cleft and Craniofacial Center, University of Pittsburgh School of Medicine; Associate Professor of Surgery (Plastic) and Pediatrics, Department of Surgery, Division of Plastic Surgery, Program Director, Plastic Surgery Residency Program, Program Director, Craniofacial Fellowship, University of Pittsburgh School of Medicine
Contributor Information and Disclosures

Updated: Feb 16, 2009

Workup

Laboratory Studies

  • The rule of 10 is the long-standing guideline to determine when a neonate is fit for surgical repair.55 This rule mandates that the infant weigh at least 10 lb, be aged at least 10 weeks, and have a minimum hemoglobin level of 10 g/dL before surgery is considered. This rule has often excluded neonates younger than 28 days. However, new advances in neonatal anesthesia have made surgery possible in those excluded by these guidelines.
  • Hemoglobin studies, hematocrit studies, and platelet counts are routinely obtained, and the neonate is evaluated by the appropriate anesthesia team. Any cardiac or respiratory problems are addressed prior to surgery with the appropriate referrals made, as needed.

Imaging Studies

Cleft lip can be diagnosed prenatal with ultrasonography as early as 20 weeks. A prenatal ultrasound diagnosis should be followed promptly with a consultation with a multidisciplinary cleft team for parent counseling and discussion of expectations. Parents should be advised that while ultrasound technology continues to be more refined, it can underestimate the degree of actual clefting.

Other Tests

Genetics consultation and workup should be considered in all patients with cleft lip and nose. It is especially important if the patient has other anomalies or has a family history of clefting.

Cleft lip and nose are often associated with clefting of the palate. These children often have difficulties with sucking, feeding, and weight gain that require evaluation by a feeding specialist; they may need special bottles and nipples.

More on Craniofacial, Unilateral Cleft Nasal Repair

Overview: Craniofacial, Unilateral Cleft Nasal Repair
Workup: Craniofacial, Unilateral Cleft Nasal Repair
Treatment: Craniofacial, Unilateral Cleft Nasal Repair
Follow-up: Craniofacial, Unilateral Cleft Nasal Repair
Multimedia: Craniofacial, Unilateral Cleft Nasal Repair
References
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Further Reading

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Keywords

cleft lip nasal deformity, cleft rhinoplasty, cleft nose, cleft nasal deformity, cleft feature, nasal deformity, deformed nose, nose deformity, nasal cleft repair, nasal cleft deformity, nasal reconstruction, nose reconstruction, cleft lip repair, clefting syndrome, cleft nasal abnormality, cleft nasal anomaly, harelip, hare lip, lagocheilos

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Contributor Information and Disclosures

Author

Mimi T Chao, MD, Consulting Surgeon, Pediatric Plastic Surgery, Children's Hospital Central California
Mimi T Chao, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society of Craniofacial Surgery, American Society of Maxillofacial Surgeons, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph E Losee, MD, FAAP, FACS, Chief, Division of Pediatric Plastic Surgery, The Children's Hospital of Pittsburgh; Director, Pittsburgh Cleft and Craniofacial Center, University of Pittsburgh School of Medicine; Associate Professor of Surgery (Plastic) and Pediatrics, Department of Surgery, Division of Plastic Surgery, Program Director, Plastic Surgery Residency Program, Program Director, Craniofacial Fellowship, University of Pittsburgh School of Medicine
Joseph E Losee, MD, FAAP, FACS is a member of the following medical societies: Allegheny County Medical Society, Alpha Omega Alpha, American Association of Pediatric Plastic Surgeons, American Cleft Palate/Craniofacial Association, American Society of Craniofacial Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, Northeastern Society of Plastic Surgeons, Ohio Valley Society of Plastic Surgeons, Pennsylvania Medical Society, Plastic Surgery Research Council, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

S Anthony Wolfe, MD, Chief, Division of Plastic Surgery, Miami Children's Hospital; Voluntary Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine
S Anthony Wolfe, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic and Reconstructive Surgery, Florida Medical Association, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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