Primary correction of the unilateral cleft nasal deformity

An 18-year experience with the management of the unilateral cleft nasal def ormity in 1200 patients is presented. A primary cleft nasal correction was performed at the time of lip repair in infancy; a secondary rhinoplasty was done in adolescence after nasal growth was complete. The technical details of the authors' primary cleft nasal correction are described. Exposure was obtained through the incisions of the rotation-advancement design. The car tilaginous framework was widely undermined from the skin envelope. The nasa l lining was released from the piriform aperture, and a new maxillary platf orm was created on the cleft side by rotating a "muscular roll" underneath the cleft nasal ala. The alar web was then managed by using a mattress sutu re running from the web cartilage to the facial musculature. In 60 percent of cases, these maneuvers were sufficient to produce symmetrical dome proje ction and nostril symmetry. In the other 40 percent, characterized by more severe hypoplasia of the cleft lower lateral cartilage, an inverted U infra cartilaginous incision and an alar dome supporting suture (Tajima) to the c ontralateral upper cartilage were used. Residual dorsal hooding of the lowe r lateral cartilage was most effectively managed with this suture. This pri mary approach to the cleft nasal deformity permits more balanced growth and development of the ala and domal complex. Some of the psychological trauma of the early school years may be avoided. Also, because of the early repos itioning of the cleft nasal cartilages, the deformity addressed at the time of the adult rhinoplasty is less severe and more amenable to an optimal fi nal result.