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Individuals born with a cleft lip also
have an associated characteristic nasal deformity. Cleft
lip nasal deformity has lack of development of some
elements of the nose and displacement of other parts
of the nasal anatomy. The cartilage giving shape to
the tip of the nose is usually underdeveloped, flattened
with less projection, and positioned lower than the
tip cartilage on the non-cleft side. The nostril shape
and width are different. The septum is deviated toward
the non-cleft side. One consequence of these cleft lip
nasal deformities is nasal airway obstruction. Another
consequence may be an appearance that lacks symmetry
and displays a characteristic appearance in the nose
that may remain a reminder of the cleft lip, even after
the best of cleft lip surgical repair.
Cleft Lip Nasal Surgery is done to improve the appearance
of the nose and the ability to breathe through the nose.
Because the surgery is reconstruction of a birth deformity
and improves the nasal airway, it is usually covered
by insurance plans. Some correction may be possible
at the time of the initial cleft lip repair, but additional
reconstruction or revision may be required when nasal
maturity of adult proportions has been completed in
the mid-teen years.
Nasal aesthetics are central in our appreciation and
the attractiveness of the face. The balance of elements
of the nose from any point of view affects the overall
balance and aesthetics of the entire face. Understanding
nasal aesthetics and the interdependence with the rest
of the face is as important as the technical skill and
experience required to perform this elegant and complex
operation.
Rhinoplasty is
generally considered among the most difficult and challenging
procedures in plastic surgery because small changes
can have important consequences in the appearance or
airway function. Cleft lip nasal surgical correction
requires additional experience and skills beyond that
of basic cosmetic rhinoplasty techniques. Dr.
Weeter has been caring for patients with cleft lip
and palate throughout his career in plastic surgery.
He leads a cleft lip and palate team in Louisville,
Kentucky. He has also been a team leader for volunteer
medical groups going to Central and South America to
care for patients with these conditions and to teach
local surgeons these specialized skills. He is a member
of the American
Cleft Palate-Craniofacial Association.
Dr. Weeter begins with a thorough consultation to understand
the patient’s goals and carefully evaluates size
and shape of the various nasal elements, the overlying
skin, the internal airway, and the relationship to other
facial features. Planning and surgical precision are
of critical importance. Dr. Weeter’s goal is to
achieve as natural a result as possible.
WHO IS A CANDIDATE
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A patient who has had
a single (unilateral) or double (bilateral) cleft
lip. |
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A patient with one or more family
members who have had a cleft lip and also has asymmetry
of the nose. |
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A cleft patient whose nose is cosmetically
unattractive or does not have a pleasing balance
with other facial features. |
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Overly prominent elements of the
nose or underdeveloped parts of the nose. |
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A patient whose nose is crooked,
too wide, long, excessively projecting, or flat.
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A cleft patient whose nasal septum
(the cartilage separating the right and left internal
nasal passages) is deviated and causes nasal airway
obstruction. Correction of a deviated septum alone
is called a septoplasty or submucous resection of
the septum (SMR). A crooked nose may worsen this
disorder and therefore, require correction at the
same time. This surgery is called a rhinoseptoplasty.
Turbinates are parts of the nose that help to add
moisture and filter inspired air. These structures
can be enlarged for many reasons and contribute
to airway obstruction. When this occurs, Dr. Weeter
will recommend their removal as part of the nasal
surgery. Other problems, such as narrowed passages
and airway "collapse", may require placement
of cartilage grafts for structural support. Occasionally,
scar tissue within the nose from previous injury
or surgery may block airflow and require correction. |
INSURANCE COVERAGE
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When reconstructive nasal
surgery is done to restore normal airway function
or appearance, insurance benefits may cover some
of the costs associated with these surgical procedures.
Dr. Weeter’s office will assist in obtaining
pre-authorization from your insurance company. |
INTENDED RESULT
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Before
and After
Cleft Lip Nasal Surgery
(click on any
photo to enlarge) |
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Improved symmetry of
the nose with proper balance of the nasal elements. |
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Correction of breathing difficulties
caused by fixed anatomical obstruction. |
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A more attractive nasal shape with
the nose in better proportion to other facial features. |
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Maintenance of the patient’s
individuality. |
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Realistically, there are limitations
in achieving the final goal and the ultimate outcome
will vary from patient to patient due to the characteristics
of the individual’s skin, cartilage, and bone. |
PROCEDURE DESCRIPTION
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The rhinoplasty may be
done with local anesthesia and intravenous sedation
in the safety of an accredited outpatient surgery
facility. General anesthesia may be used upon patient
request or physician recommendation. |
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Some rhinoplasties have incisions
hidden within the nostrils, inside the nose. More
complex nasal operations often require a small incision
in the narrow strip of skin between the nostrils.
This tiny scar is barely visible, yet it allows
the surgeon to "lift" the nasal skin and
directly view all of the cartilage and bone requiring
correction. This is termed an open rhinoplasty.
To narrow flaring nostrils, small incisions are
placed in the groove where the nostril meets the
cheek. |
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Septal cartilage and bone or other
obstructing tissues can be relocated or moved, as
required. |
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Cartilage and bone grafts, if required,
are most often taken from within the nose. Ear cartilage
is another possible source of graft material to
rebuild the underlying architecture. |
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After the underlying framework of
cartilage and bone has been modified, the skin is
redraped. |
RECUPERATION AND HEALING
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An external cast or splint
will be placed immediately after surgery. The nose
may be packed for 24 to 48 hours. Your cast or splint
is usually removed in 7-10 days. |
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Initial discomfort is easily controlled
with oral medications. |
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The majority of swelling and bruising
subsides progressively over 2 to 4 weeks. |
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External sutures (if any) are removed
in 4 to 6 days. The internal sutures will dissolve. |
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Return to work may be possible in
about 7 to 14 days, depending on the nature of your
responsibilities at work. |
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While the visual improvements and
better breathing should be apparent relatively soon
after the swelling diminishes, a realistic approximation
of your final result is evident in 3 months. The
final result will continue to evolve and refine
for 12 to 14 months. |
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Areas of sensitivity or numbness
will slowly resolve. Temporary conditions that may
occur, but will improve over the first several months,
are stiffness of the tip of the nose, nasal drainage,
lumps and irregularities. |
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Dr. Weeter will personally see you
for post-operative care at prescribed intervals
to evaluate your progress and answer questions.
His follow up care will go on for several years
as the healing tissues mature to the ultimate improvement. |
OTHER OPTIONS
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Chin augmentation with
a small synthetic implant may help create better
facial harmony and an improved profile for some
patients. |
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Revision of the cleft lip repair
scar or surgery to achieve better symmetry or balance
of the lip with other facial features. |
| NOTE: The specific risks
and the suitability of this procedure for you may be determined only at
the time of consultation. All surgical procedures have some degree of risk. |
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