MOC-PS(SM) CME Article: Late Cleft Lip Nasal Deformity

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the components of unilateral and bilateral secondary or delayed cleft lip nasal deformity. 2. Design and execute the surgical correction more logically. 3. Minimize the risks and better manage complications and suboptimal outcomes. Summary: Rhinoplasty remains one of the most challenging plastic surgery procedures, and patients with a cleft lip nose deformity pose an even greater challenge. The biggest enigmas are achievement of caudal nose congruity and creation of symmetric nostrils. This article reviews the factors to consider when assessing a patient for correction of secondary cleft lip nasal abnormalities and the surgical techniques available to correct the deformities. Some of the components of the unilateral cleft lip nose deformity include asymmetric tip, short columella, long lateral crus, flat nostril, wide alar base, caudal positioning of the nostril floor on the cleft side, and a short and deviated columella. The common features of bilateral cleft lip nose deformity include short columella, underprojected tip, flat alae, and wide and often asymmetric and horizontal nostrils. While an endonasal approach can improve these noses, the most success is attained through an open technique. Systematic reorientation of distorted nasal architecture, especially the lower lateral cartilages, and creation of a balanced platform for the lower lateral cartilages constitute some of the cardinal principles for correcting the cleft lip nose deformities. Potential complications and ways to minimize them are discussed. The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.