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The Minimizing the Secondary Rhinoplasty with Nasal Reconstruction at the Time of Primary Cleft Lip Repair
Katie Weichman, MD, Nicholas T. Haddock, MD, Mark H. McRae, MD, Court B. Cutting, MD.
New York University Langone Medical Center, New York, NY, USA.

PURPOSE:
The senior author routinely performs primary nasal reconstruction with each cleft lip repair. This evolution has in turn created a new breed of secondary rhinoplasty patients, which are approached with less radical techniques similar to those utilized in the aesthetic rhinoplasty.
METHODS:
A retrospective chart review was completed of all cleft secondary rhinoplasties. The indications for secondary rhinoplasty were examined, the anatomical features of the nose at the time of operation were documented and the reconstructive techniques utilized were recorded. Patients were divided into those that underwent nasoalveolar molding and primary rhinoplasty by the senior author and those that were treated by other surgeons. These groups were compared. Persistent anomalies at the time of secondary rhinoplasty in the senior author’s patients were analyzed for potential technical modifications at the time of primary rhinoplasty.
RESULTS:
From 2001 to 2009 the senior author performed 215 secondary rhinoplasties in patients with a previously repaired cleft lip. The senior author performed 59 of the initial cleft lip repairs. In this group a depressed dome was seen in 52.5%, lateralized alar base in 60.0%, short columella in 35%, deviated septum in 87.2% and a vestibular web in 41% patients. A Dibbell rhinoplasty was required in 20.0%, a Potter rhinoplasty in 2.5%, a Tajima inverted U in 65.8%, and an alar base resection in 56.4%. For those patients that did not undergo cleft lip repair with primary rhinoplasty by the senior author a depressed dome was present in 80.9%, lateralized alar base in 63.6% short columella in 63.6%, deviated septum in 81.7% and a vestibular web in 14.7%. 50.7% required a Dibbell rhinoplasty, 1.4% required a Potter rhinoplasty, 67.1% required a Tajima inverted U, and 60.9% required an alar base resection.
CONCLUSION:
Primary nasal reconstruction with cleft lip repair has produced consistent results. Following nasoalveolar molding and primary rhinoplasty at secondary rhinoplasty the lower lateral cartilages are more symmetrically aligned with a near normal loop length. This allows for a less radical secondary rhinoplasty procedure. Critical evaluation of persistent anomalies highlights potential modifications to the initial cleft nose procedure.


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