Table 2 Nasal deformities associated with unilateral and bilateral clefts and our surgical solutions
unilateral cleft | bilateral cleft | surgical solutions unilateral/bilateral |
|---|---|---|
perpendicular plate deviates towards the cleft side | shortened columella | resection of the deviated bony septum/columellar skin gained by V-Y plasty |
nasal spine deviates towards the non-cleft side | lack of septal cartilage in the anterior columellar region | not corrected/columella strut graft is used |
bony pyramid deviates towards the non-cleft side | downward rotation of the nasal tip | bony pyramid replacement vis medial and lateral osteotomies/tip projection provided by the columella strut |
lateral displacement of the alar base at the cleft side | bifidity of the nasal tip | lower lateral cartilage replacement/tip refinement with sutures and/or shield/tip grafting |
downward displacement of the alar cartilage at the cleft side | buckling of the lateral crura on both sides | in both cases alar cartilage replacement and the two medial crural cartilages sutured together with the columella strut |
asymmetry/bifidity of the dome area | usually no severe septal deviation | in both cases tip refinement with sutures and/or grafting |
down position of the medial crus at the cleft side | downward rotation of the alar cartilage | in both cases tip projection provided by the columella strut |