Cleft Rhinoplasty Post Cleft Lip Repair
Mount Sinai’s Division of Facial Plastic and Reconstructive Surgery is a global leader in the treatment of cleft lip nasal deformity, a congenital defect that is associated with nasal asymmetry and difficulty breathing. Our surgeons continue to advance standards for treatment, using cleft rhinoplasty techniques that enhance overall nasal function while minimizing visible signs of scarring.
About Cleft Lip
Cleft lip is a congenital defect in which the skin and muscle below the nose do not completely join prior to birth, resulting in an opening or split. While this affects the function of the lip, it also negatively impacts the form and function of the nose. This defect most commonly presents unilaterally (on one side of the nose), but it can also be bilateral. It occurs in approximately one out of every 1,000 births in the United States each year.
In some cases, cleft lip is associated with a cleft palate, in which the roof of the mouth does not completely join prior to birth. This defect can result in dental, feeding, and speech issues, as well as difficulty with drainage of the middle ear, which can lead to recurrent ear infections and hearing loss. Cleft lip with cleft palate occurs in approximately one out of every 1,600 births in the United States each year.
Cleft Rhinoplasty for Teens with Cleft Lip
Patients with a cleft lip -- with or without cleft palate – may undergo multiple surgical procedures to reconstruct both the lip and the nose, the first of which starts approximately 10 weeks after birth. The final surgical repair is typically a cleft rhinoplasty, which is most often performed between the ages of 15 and 17.
Cleft rhinoplasty is similar to a traditional rhinoplasty in that it can improve the form and function of the nose. However, it is a more complicated procedure due to the altered anatomy of the nose and scarring from previous surgical repairs. In some cases, patients decide not to undergo cleft rhinoplasty, as they are satisfied with the improvements they achieved in nose function and appearance through prior surgeries. In other cases, patients are not suited for cleft rhinoplasty due to a medical comorbidity or unrealistic goals for outcomes.
At Mount Sinai, we use a specialized approach to cleft rhinoplasty that involves using the existing lip scar from the prior cleft lip repair to enhance the shape and function of the nose. We reposition this scarred skin into the nose, which helps address the relative lack of internal nasal lining on the cleft lip side and allows us to optimize the cleft lip scar simultaneously. This results in an improved appearance for both the nose and lip scar and can reduce the need for grafting from other areas of the body.
What Are the Results of Surgery?
Cleft rhinoplasty is safe and effective in achieving a more aesthetically balanced nose with improved breathing function. However, it is challenging to achieve perfect symmetry, particularly when viewing the nose from below when the patient is looking up. We are thoughtful and careful with setting expectations for outcomes with parents and each patient prior to surgery.
Additionally, it can take up to one year for swelling around the nose to completely subside. Hence, it may take time to fully appreciate the overall improvements in appearance.