Deformity of the nose occurs in varying degrees along with cleft lips. Although the lip gets corrected early on in life, the nose deformity persists as a stigma and it causes mental trauma to the affected.
The correction of such deformities is challenging and the results are rewarding. Nose function, as well as appearance, gets major improvement by surgery. The days are gone when such surgeries were done in surgical camps. More and more patients are seeking better care and attention. Restoration of near normal appearance should be the goal. The surgical options are many and varied. The results depend on judicious selection of technique keeping in mind the nature of the deformity. Results are permanent.
COMPONENTS OF CLEFT LIP NOSE DEFORMITY.
The striking features of a cleft lip nose deformity are: –
- The deviation of nasal tip.
- Flattening and buckling of the outer wall of nostril.
- Widening of the nostril on the affected side.
These are a few other deformities which go along with these like deviation of the septum, bulbous tip, excess skin inside the nostril, and low nasal bridge. The severity of the deformities varies between different individuals.
TIMING OF NOSE CORRECTION
The nose deformity /should be addressed at the time of cleft lip closure. This is primary nose correction and gives good results. If the nose was not corrected early in childhood, the best time would to do so would be after completion of facial growth i.e. 14 – 16 years.
METHOD OF CORRECTION
The surgical plan depends on the deformity and patients expectations. The bony and cartilage framework can be altered to create an aesthetically appealing nose. Skin excess can be trimmed or readjusted.
Implants may be employed in selected cases to improve the profile. The scar on the lip can be improved upon at the same time. In some cases, the upper lip needs to be plumped up. This is also done in the same sitting permanently using the patients own tissue.
The surgery is done as a day care procedure and under general anesthesia.
The nose may be packed with gel foam for two days. Tapes over the nose come off in 4 days. Swelling over the nose takes a while to go off. Most of it resolves in 2-3 weeks.