Secondary rhinoplasty in the cleft lip patient

Secondary rhinoplasty in the cleft lip patient. Secondary surgery of the cleft lip nose is very complex due to its specific pathological anatomical characteristics. In this article, the general and specific characteristics of the nose of the unilateral and the bilateral cleft patient are described, and careful preoperative assessment is emphasized. Considerations concerning the timing of the operation before or after the puberty growth spurt are discussed. Guidelines are given for a systematic correctional surgical approach, dividing the operative procedure into septal surgery, tip surgery, osseo-cartilaginous vault surgery, maxillary augmentation and alar base reallocation. A description is given of special postoperative care with a custom-made vestibular device to prevent stenosis of the vestibulum and deformation of the nasal tip caused by scar tissue retraction in the postoperative period.