April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Volume 140, Number 1 • Correction of Cleft Lip Nasal Deformity

Conclusions Proper correction of cleft lip nasal deformity requires a thorough knowledge of the bony, car- tilaginous, and soft-tissue anatomy that consti- tutes the initial deformity, an understanding of the iatrogenic contributions, and an apprecia- tion of the changes that occur with growth. Early (primary) nasal correction at the time of cleft labial repair provides a cartilaginous foundation that minimizes subsequent deformity but does not obviate the likely need for “revisions.” This article highlights specific techniques for inter- mediate correction that are safe and effective during late childhood and early adolescence. We advise against any nasal revision during puberty. Rhinoplasty, undertaken in young adulthood, is both functional and aesthetic, and it is among the most challenging, creative, and rewarding of procedures. John B. Mulliken, M.D. Department of Plastic and Oral Surgery Boston Children’s Hospital 300 Longwood Avenue Boston, Mass. 02115 john.mulliken@childrens.harvard.edu PATIENT CONSENT Parents or guardians provided written consent for use of patients’ images. ACKNOWLEDGMENTS The authors thank Jeffrey R. Marcus, M.D., opera- tive surgeon in Video 2 on cleft rhinoplasty, and Agustin Cornejo, M.D., for assistance with editing this video. REFERENCES 1. Monson LA, Kirschner RE, Losee JE. Primary repair of cleft lip and nasal deformity. Plast Reconstr Surg . 2013;132:1040e–1053e. 2. Henry C, Samson T, Mackay D. Evidence-based medi- cine: The cleft lip nasal deformity. Plast Reconstr Surg . 2014;133:1276–1288. 3. Zbar RI, Canady JW. An evidence-based approach to secondary cleft lip nasal deformity. Plast Reconstr Surg . 2011;127:905–909. 4. Byrd HS, El-Musa KA, Yazdani A. Definitive repair of the unilateral cleft lip nasal deformity. Plast Reconstr Surg . 2007;120:1348–1356. 5. Guyuron B. MOC-PS(SM) CME article: Late cleft lip nasal deformity. Plast Reconstr Surg . 2008;121(Suppl):1–11. 6. Atherton JD. A descriptive anatomy of the face in human fetuses with unilateral cleft lip and palate. Cleft Palate J . 1967;4:104–114. 7. McComb H. Primary correction of unilateral cleft lip nasal deformity: A 10-year review. Plast Reconstr Surg . 1985;75:791–799.

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