eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Unilateral Cleft Nasal Repair: Follow-up

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

Outcome and Prognosis

The approach to the cleft lip nasal deformity has evolved over the years. The previous hesitation of primary nasal repair at the time of lip repair has largely been assuaged by long-term studies that have shown no detrimental effects on nasal growth with early surgery. In support of early cleft lip nose repair, McComb reviewed his first 10 consecutive cases of primary cleft lip nose repair after 18 years.30 His results supported the observation that growth of the cleft side of the nose is unaffected by early primary nasal surgery and that the vertical shortening of the nose by the alar lift technique is preserved into adult life. Residual nasal asymmetry resulted secondary to the septal deviation.

Nonetheless, even with primary repair, most children need secondary nasal revisions of varying magnitude. Definitive open septorhinoplasty should be delayed until the teenage years and after maxillary advancement, should it be necessary.

Future and Controversies

Controversies still exist regarding presurgical orthopedics, nasal molding, the optimal timing of surgery, what technique to use, and how aggressive the surgical intervention should be prior to skeletal maturity. However, the ultimate goal for children with cleft lip, nose, and palate is to "achieve optimal facial balance and harmony, normal speech, beautiful smile, and full dentition with normal occlusion, resulting in an attractive face with stigmata of clefting at a conversational distance."9 The future for the plastic surgeon is to achieve this goal with the fewest procedures and the lowest burden on patients and their families.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Zachary Segal, MD; W Scott McDonald, MD; and Seth R Thaller, MD, DMD, FACS, FAAP to the development and writing of this article.



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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