Rhinoplasty in Cleft Lip-Nasal Deformity: A Clinical Case

Babak Azizzadeh, MD; Donald B. Yoo, MD


March 07, 2012

Case Presentation: Adult Woman With Inadequate Primary Repair of Cleft Lip-Nasal Deformity

A 32-year-old woman with a history of unilateral right cleft lip and cleft palate repair presents with residual right-sided oronasal fistula, nasal dysmorphia, and septal deviation toward the right. The original repair resulted in a residual oronasal fistula and a cleft nose.

On external examination, the patient has foreshortening of the columella, with the base oriented away from the cleft side. The septum deviates toward the cleft side, displacing the tip toward the contralateral side. The nasal bones and maxilla on the right side are underdeveloped, causing inferolateral displacement of the right alar base and displacement of the nasal dorsum toward that side. Malposition of the ala contributes to rim weakness of the right ala, resulting in a more horizontal shape to the nostril and a narrower aperture of right vs. left. Overall, the patient's nose has a very deep radix with low dorsum, a low nasal starting point, and a greatly underprojected nasal tip.