Cleft Rhinoplasty is a reconstructive cosmetic surgery that helps in reshaping and normalising of the nose deformity which would have been present from birth and caused by congenital presence of the cleft lip and plate. Presence of the nose deformity specially after correction of the cleft lip and palate in childhood makes the person very conscious and draws attention to the abnormality, consequence of this is the increased demand of cleft lip rhinoplasty by patients in their later years. There are two types of cleft rhinoplasty- Primary rhinoplasty and secondary rhinoplasty. Primary cleft rhinoplasty is undertaken at the time of primary cleft lip repair while secondary cleft rhinoplasty is a revision rhinoplasty to correct the residual deformity remaining after the primary cleft lip surgery. Cleft rhinoplasty is a complex procedure and must be addressed at the right age which is usually when the growth of the person is complete.
The incidence of cleft is 1: 850. In ancient time cleft was addressed as an evil spirit and the babies suffering from it were abandoned. However, Boochai found the principle reason behind the presence of clefts. With significant evolution about cleft surgery in today’s world there are numerous techniques described for correcting such deformity called the cleft nose rhinoplasty. Children suffering with cleft lip nose deformity have associated feeding difficulties, speech impairment, hyper-nasalis, breathing difficulties, etc. so much so that many a times their day-to-day activities become a concern. They suffer with emotional, psychological and functional distress. Social acceptance is reduced in such patients.
Specialised doctors like Plastic surgeons, Pediatric Surgeons or Cleft surgeons are authorised to treat such cases. A multi- disciplinary approach is undertaken to treat cleft lip nose deformity. The aim of the Cleft nose surgery is to correct the deformity and restore normal functioning, and growth. The surgery of repairing the cleft nose is called “Cleft nose Rhinoplasty”. Along with the functional correction our surgeon also makes it cosmetically pleasing which not only improves the patient’s aesthesis but also helps in enhancing the patient’s self-confidence and self-esteem. This is a comparatively difficult procedure as compared to a regular rhinoplasty.
WHAT ARE THE CHALLENGES FACED?
- Late appearance of the patient is very challenging in primary cleft rhinoplasty because the later they report the difficult it is to achieve an anatomic closure between the two margins of the cleft lip deformity.
- Aesthetic correction becomes more difficult in secondary cleft rhinoplasty
- Abnormal shape in the nasal tip cartilage, nasal bones, and nasal septum.
- Secondary Cleft rhinoplasty is a complicated surgery due to the presence of scar tissues
HOW IS NOSE AFFECTED BY THE CLEFT?
- Presence of a cleft affects the growth of facial tissues. Growth is more restricted on the cleft side as compared to the non-cleft side.
- Nasal air flow and speech is altered due to escape of air from the cleft margins.
- In unilateral cleft nose, the affected side of the nose is smaller than the unaffected counterpart. The nasal airway on the affected side is smaller due to significant deviation of the nasal septum.
HOW IS THE CLEFT NOSE SURGERY UNDETAKEN?
- By correcting the difference in the lateral walls of the nose
- By changing the size and the shape of the nostrils so as to make them similar
- Improving the nasal projection and giving a sharp nasal tip
- Lengthening a short nose for a better profile
- Removing bumps or ridges
- Improvement in the respiration.
CLEFT RHINOPLASTY SURGERY:
PRIMARY CLEFT NOSE SURGERY:
- Primary cleft nose surgery is generally performed during the initial surgery for the repair of cleft lip under general anaesthesia. Cartilage and bone grafts are usually not used at such a young age as usually these procedures are undertaken in the first few years of life. The tissues are repositioned so that the later growth can make the tissues look more normal.
- The main aim of the procedure is to bring the cleft margins together and enhance the growth of the nose in a balanced way
- Cleft nose is to be repaired within 5 years of age. This technique of early repair is called Primary cleft rhinoplasty
- This helps for functional and aesthetic improvement of the nose and the face.
- Less scarring is seen in Primary Cleft rhinoplasty.
SECONDARY CLEFT NOSE SURGERY:
- The secondary cleft nose surgery is generally complex and hence is undertaken under general anaesthesia.
- An open rhinoplasty procedure is the preferred one. A small incision is made in the base of the nose and areas that are to be corrected are addressed through this small incision.
- Depending upon the situation and the strength of the cartilage and bones, a variety of techniques are used in order to reshape the nose as well as improve breathing.
- The graft material can also be used to correct deficient areas specially to advance the nasal tip.
- Deviation can be corrected in this stage.
- This revision rhinoplasty is performed after skeletal growth is complete i.e., after 16-18 years for women and 18-21 years for men.
- Septoplasty is undertaken so as to address the nasal blockages.
- Any communication between the nose and the mouth can be closed and stitches or sutures are placed to seal the site.
- TCartilage grafts are placed to correct the curvature of the nose opening.
- Soft splints are placed to maintain the contour of the nose post-operatively.
- Cleft Rhinoplasty is generally an outpatient procedure.
RECOVERY AFTER PRIMARY CLEFT NOSE SURGERY:
- Parents will be instructed to not allow the child to sleep on the affected side after a cleft rhinoplasty.
- Patient will be put on intravenous antibiotics and pain killers.
- Feeding instructions will be explained to the parents
- Arm restriction to prevent any harm to the site of the surgery.
- Certain dietary restrictions must be followed.
- Recovery is comparatively faster at early age
RECOVERY AFTER SECONDARY CLEFT NOSE SURGERY:
- Similar instructions will be given for secondary cleft rhinoplasty.
- Nasal packing and splintage of the nose will be done after any nose surgery but specially after cleft nose surgery.
- However, recovery time is expected to be longer than that of the primary cleft rhinoplasty surgery.
CLEFT RHINOPLASTY COST:
On an average the cleft rhinoplasty cost is more than any nose surgeries as there are a plethora of procedures that are undertaken which include Cleft rhinoplasty, cartilage harvest from the ear, cartilage harvest from the costal margin and also tissue harvest. At the same time I would like to mention that the Cleft rhinoplasty cost in India is very affordable.