Cleft lip and palate are deformities that result from certain deficiencies during embryologic development and present at birth. Typically, they occur due to the failure of the medial nasal prominence to fuse with the maxillary prominence. These patients usually undergo cleft lip repair at around 3 months of age and cleft palate repair at 9–10 months. Later on, they often require middle ear treatments and speech therapy. However, the nasal deformity in these patients can only be partially corrected at an early age, and definitive correction becomes feasible between the ages of 15 and 18.
So, should these patients be approached in the same way as patients without any cleft lip or palate deformities? The answer is clearly no.
Surgery in these patients differs from the standard primary rhinoplasty. First, let’s consider the main problem in such cases. As shown in the adjacent image (Image-1), the upper nasal vault and upper bony framework are generally similar to those in individuals without this deformity. There is no significant difference in those areas. The main difference lies in the lower one-third of the nose. On the cleft side, the nostril is flattened and depressed, the alar rim is elongated, and the alar base is displaced upward and backward.
These deformities cannot be corrected with standard rhinoplasty techniques alone. Instead, additional techniques—previously described but not typically performed in routine rhinoplasty—must be employed to restore symmetry with the opposite side.
