OUR CONCEPT OF RHINOPLASTY IN PATIENTS WI TH CHEILOGNATHOURANOSCHISIS

In the treatment of patients with cheilognathouranoschisis, rhinoplast y is a great challenge, since the cleft lip and palate will also produ ce nasal deformation requiring surgical correction. Unilateral cleft l ip and palate is usually associated with a pronounced septal deformity resulting in ''crooked nose'' as well as typical asymmetry of the ape x of the nose and of the nasal vestibule. The anterior part of the sep tum is dislocated in the direction of the unaffected side and the lowe r border of the septum is at the same time subluxated to the opposite side. The dorsal part of the septum presents with a convex deformity t owards the cleft side extending in horizontal and vertical direction. Severe septal deformities cannot usually be adequately corrected on th e spot, i.e. loco, but since septal correction is of paramount importa nce for the appearance and functioning of the nose we performed an ext racorporeal correction of the septum in 191 cleft patients during the period from January 1980 through May 1993. Another characteristic feat ure of the cleft nose is the oblique modiolus, or columella cochleae, which is shortened on the cleft side, and the S-shaped deformity of th e lateral alar cartilage, which presents with a cranial dislocation in the dome, caudal deviation in the lateral part, and an overhanging al a. After correction of the entire cartilaginous nasal framework the su rgeon is usually confronted with asymmetry of the soft tissue. Satisfa ctory correction can be achieved by means of a three-flap technique in the region of the modiolas, nasal ala and vestibular skin: A modiolus -based transpositional flap results in a symmetrical height of the mod iolus. By means of a second transpositional flap which is based at the rim of the ala and turned into the nasal vestibule, the nasal ala can be elevated to a level that is symmetrical to the unaffected side. El evation of these two flaps usually results in a minor defect in the do me, which is corrected using a third flap from surplus of vestibular s kin. We have so far successfully used this technique in 174 patients.