Clinical Professor,
Plastic Surgery,
Kolkata, India.
Phone: +91-33-4420-2122
Cell: +91-987-463-3896
Secondary Cleft Rhinoplasty: Enhancing Nasal Form & Function
Rhinoplasty in Cleft Children: Final Step of a Long Reconstruction Journey
Fixing the facial appearance of children born with cleft lip and palate is a huge goal. But it takes many years and involves many surgeries in childhood. Finally, rhinoplasty surgery caps off this long journey. It fixes the last nasal deformities that earlier repairs could not correct.
Children born with facial clefts of the lip and palate have deficient facial growth. On the cleft side, facial bones do not grow well. These also include the nasal bones and cartilages. Even after correcting lip and palate defects, the nasal deformity lingers. Thus, children with cleft lip and palate require a final surgery called a rhinoplasty.
Skilled plastic surgeons use rhinoplasty to re-create natural, symmetric nasal contours. These contours are in harmony and balance with the rest of the face. Most importantly, it has a substantial psychological impact. It ends the visible cleft stigma and lets patients feel comfortable with their looks.
The Necessity for Secondary Cleft Rhinoplasty
Rhinoplasty allows plastic surgeons to rebuild the nose's support systems and fix deficient areas. Following that, a deformed nose appears smoother and more symmetric. This type of rhinoplasty is the most challenging, as it deals with severe nasal deformities caused by clefts.
Age for Performing Secondary Cleft Rhinoplasty
A rhinoplasty significantly improves the appearance and function of the nose. As plastic surgeons, we perform this extensive nose surgery once the patient's face has stopped growing. Typically, it occurs around the ages of 16 to 18 for girls and 17 to 19 for boys.
The Long Journey of Cleft Lip Palate Repair.
Children born with cleft lips have a gap or opening in their upper lip. In cleft palate, the gap is in the roof of the mouth. A child may have an opening in one or both areas.
To fix these birth defects, they need many surgeries from a very young age. The first surgeries happen when they're babies. These surgeries close the cleft lip and palate openings, enabling proper eating, breathing, hearing, and speaking.
As the child grows older, they may need more procedures. These will be on their gums, jaws, and other facial areas. This complex journey of cleft repairs often spans throughout childhood.
A Lingering Nose Deformity in Cleft Children
Even after the initial cleft surgeries, most children still have deformed noses. Their noses may look crooked or off-centre. One nostril may appear more narrow or more deformed than the other. Sometimes, the nasal tip cartilages may collapse inward, leading to a pinched or asymmetrical appearance.
Enhancing Nasal Structure with Grafts: Autologous and Non-autologous
As plastic surgeons, we use grafts or implants to reconstruct and support the nasal framework during surgery. We may source these grafts from the patient's cartilage or bones (autologous) or synthetic (non-autologous) materials.
Autologous Materials
We may use cartilage from the patient's nasal septum or rib to create thin grafts. The grafts provide essential support by acting as pillars, braces, or supports strategically placed in specific areas. These cartilage grafts help straighten, project, and strengthen the collapsed nostril area. They also reinforce the nasal sidewalls on the cleft side.
Non-autologous Materials
In some cases, we may use unique implants made up of porous, high-density polyethylene to fix areas of deficiency. We can carve these custom implants into shapes like struts or battens. We build up the collapsed nasal lining and sidewall, which need more projection.