Cleft Rhinoplasty – Unilateral Cleft Lip and Palate
Patient born with unilateral cleft lip and palate deformity The patient is a 24-year-old female from Mannargudi in Tamil Nadu, India. She was born with a cleft lip and palate deformity on the left. Her unilateral cleft lip and palate deformity greatly distressed her parents. They were extensively counseled by the doctors soon after the birth of the child. They had referred the parents to a local dental surgeon. He had examined the patient and had referred them to a hospital in a nearby city for surgical correction. Many cleft patients have a split roof of the mouth. Her parents had presented at the hospital. As instructed by the surgeon, the patient had undergone cleft lip surgery at 3 months of age. This had been followed by cleft palate surgery at 8 months and cleft alveolus surgery at 7-1/2 years of age. She had satisfactory functional and cosmetic results from the surgery. Development of progressive nasal deformity with growth The patient began noticing the gradual development of a deformity of her nose with time. Her nasal tip was depressed and this too added to the compromise in her facial esthetics. There was also a sunken appearance to her left nostril. Her upper lip however was cosmetically acceptable. She became very self-conscious about her appearance and became withdrawn. Around two years ago, her worried parents took her to the same hospital for consultation. The surgeon had examined the patient. He then explained that she needed to undergo a closed rhinoplasty procedure or a nose job. Previous rhinoplasty correction with unsatisfactory cosmetic results The patient had subsequently undergone nasal deformity correction with the utilization of costochondral grafts. She was however dissatisfied with the results and remained withdrawn. Improper positioning of the graft had led to increased deviation to her nose. This had resulted in increased worsening of the esthetic appearance of her nose. Her parents made the decision to get this addressed and made extensive enquiries regarding the best treatment options available. They had subsequently been referred to our hospital for her secondary rhinoplasty correction. Our hospital is also a specialty center for revision rhinoplasty. A specialized cleft team consists of professionals from varied specialties. Facial plastic surgeons also perform this surgery in Europe and America. Initial presentation at our hospital for nasal deformity correction Dr SM Balaji, the cleft rhinoplasty surgeon, examined the patient and obtained imaging studies. Her nose was depressed on the left side with compromise in both esthetics and function. There was also an asymmetry to the left alar base region. She expressed her desire to have a well-defined and sharp nose. It was explained to her that an autologous costochondral cartilage graft would be used to augment her nose. The Z-plasty surgery for correction of her alar base region was also explained to her. She was in complete agreement with the treatment plan and consented to surgery. Surgical correction of her nasal deformity with closed rhinoplasty Under general anesthesia, an incision was placed over the old incision in the right inframammary region. Costochondral rib graft was harvested from the patient. Following this, a Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. A Z-plasty was then performed to correct the depressed and asymmetric left alar base. This was followed by an intercartilaginous incision to the right nostril with partial excision of the lateral nasal cartilage Dissection was then done up to the nasal dorsum and the nasal bridge was augmented using the costochondral graft. The closure was done intranasally using resorbable sutures. General anesthesia was then reversed without any complications. The patient expressed complete satisfaction with the results of the surgery The patient was very happy with the outcome of the surgery. She now had an elevated and sharp nose that was also symmetrical with a good profile. Her nasal function was also improved. She said that her breathing was unobstructed with free flow of air now. She expressed that her levels of self confidence have improved significantly after surgery. Her parents too expressed their thankfulness before final discharge from the hospital. Surgery Video
Cleft Rhinoplasty, Lip Revision Surgery, Columella Correction
Patient with asymmetrical nose and prominent lip scar The patient is a 22-year-old male from Kasargod in Kerala, India. He had been born with a cleft lip, palate and alveolus deformity. Surgical repair of his deformities had been performed at the correct prescribed times at a local hospital. The patient had subsequently developed normally with good speech and nutrition. However, there had always been residual facial and nasal deformity from the surgery. This had led to a degree of bullying during his schooling. As the patient grew older, the amount of nasal deformity had gradually increased. Nasal deformities usually involve both bone and cartilage. There was also some hypertrophic scarring at the site of the lip correction. About two years ago, the patient and his parents had visited a nearby city for consultation regarding corrective surgery. This is one of the treatments that would be addressed by a cosmetic surgeon in India. Facial plastic surgery will correct this esthetic shortcoming. Initial presentation for facial deformity correction surgery Upon viewing the patient’s deformity, the surgeon had recommended rhinoplasty with costochondral graft placement. The patient and his parents consented and surgery was performed; however, they were highly dissatisfied with the results of the surgery. The lip scarring had worsened and he had also developed breathing problems after the surgery. His breathing problems worsened considerably to the point where they visited a cosmetic surgeon in their hometown. After examining the patient, the surgeon realized that he needed to be operated at a specialty center. He had therefore referred him to our hospital for correction of his complaints. Our hospital is a specialty center for facial cosmetic surgery in India. We are also a reputed center for cosmetic rhinoplasty, cleft rhinoplasty, jaw reconstruction surgery and facial trauma surgery. Our hospital is a world renowned center for craniofacial surgery. Scores of children with craniofacial deformities have been rehabilitated in our hospital over the years and now lead normal lives. Initial presentation at our hospital for corrective surgery Dr SM Balaji, Cleft Rhinoplasty Surgeon, examined the patient and obtained a detail history. The patient complained of a depressed nose. He also said that he had developed breathing difficulties after his first surgery. The patient stated that the scar on his lip had also worsened after the previous surgery. He said that he desired to surgically have his nose and lip scar addressed. Treatment planning was explained in detail to the family. This would first involve harvesting a costochondral graft from the patient. This would be followed by lip scar revision with correction of vermillion notching and rhinoplasty correction. A strut graft would be used to correct the columellar deformity. The patient and his parents were in complete agreement with the treatment plan and consented to surgery. Various nasal shapes and deformities of the nose Shape of the nose varies widely due to differences in the shape of the nasal bone. This gives rise to the shape of the bridge of the nose. Nasal form was first classified by Eden Warwick in 1848. Nasal deformities include broad, narrow, crooked, saddle nose etc. Some birth defects such as Down’s syndrome manifest a small nose with a flattened nasal bridge. This can be due to the absence of one or both nasal bones, shortened nasal bones or unfused bones in the midline. Successful surgical correction of facial deformities Under general anesthesia, the previous surgical scar in the right inframammary region was excised. A costochondral graft was then harvested. The lip scar was excised and lip revision was done. The notching on the vermillion was also corrected. This was followed by a transcartilagenous incision to the right and left nostril. A strut graft was placed to elevate the columella. Closure of the incision was done intranasally using resorbable sutures. Total patient satisfaction at the results of the surgery The patient and his parents were very pleased with the surgery. He now had a symmetrical and prominent nose. There was also establishment of a perfect Cupid’s bow lip form. He said that he could now face social situations with complete confidence. Surgery Video
Cleft Rhinoplasty – Nose Correction
Patient born with unilateral cleft lip and palate The patient is a 26-year-old male from Kurnool in Andhra Pradesh, India. He was born with a left-sided cleft lip and palate. Cleft lip surgery and cleft palate surgery were performed before the patient was a year old. A cleft alveolus surgery was performed at the age of 7 years. The hole in the roof of the mouth was closed. All the surgeries had been performed elsewhere. The surgeries had left the patient with a deformed nose and a prominent hypertrophic scar in the upper lip. There was no hair growth in the region of the scar, which upset the patient as he desired to have a mustache. The nose was flattened and asymmetrical. He had faced a considerable amount of bullying at the hands of his peers, both in school and in college. This had made him feel depressed and reclusive. The patient always desired to possess a sharp nose that was in harmony with the rest of his face. He also said that he felt he had a decreased sense of smell and breathing problems. His parents realized that he required plastic surgery to address his problems. He and his parents approached many plastic surgeons and facial cosmetic surgeons for correction of his deformity. They were then referred to our hospital for surgical correction of his complaints. Our hospital is a renowned specialty center for the surgical correction of cleft lip, palate and alveolus deformity. Cleft lip, palate and alveolus etiology and ramifications Absence or incomplete fusion between the segments of the two halves of the upper lip segments in utero lead to the formation of a cleft lip, palate and alveolus. It could occur either due to environmental factors, injuries to the fetus, fetal infections or could have an underlying genetic basis to it. It is the most common birth defect found in newborns. Scientific research is being carried out around the world to find a way to prevent the formation of cleft lip and palate. This is very distressing to both the patients once they grow old enough to become aware and to the parents. There was a lot of stigma attached to this during the prescientific days. Better scientific understanding into the causes of cleft lip and palate has removed the stigma attached to it. Surgical correction is the only way to address this congenital facial deformity. Initial presentation at our hospital for correction of his deformities Dr SM Balaji, Facial Deformity Surgeon, examined the patient and obtained comprehensive imaging studies including 3D CT scan. All vitals were checked including blood pressure. Treatment planning was then made for the patient. The patient would need nose correction surgery, also known as a nose job. It was explained to the patient and his parents that nasal bridge augmentation would be performed with a costochondral rib graft. A strut graft would then be utilized to elevate the left nostril by means of lifting up the columella. A nose essentially has both bone and cartilage in it. Medial and lateral osteotomies would then be performed to correct the deformity along with lip revision for scar removal. The patient and his parents were in agreement with the treatment plan and consented to surgery. Successful surgical correction of the deformities Under general anesthesia, an incision was made in the right inframammary region and dissection was carried down to the ribs. A costochondral rib graft was then harvested followed by a Valsalva maneuver to ensure a patent thoracic cavity. The incision was then closed in layers with sutures. An intercartilagenous incision was then made followed by medial and lateral osteotomies to correct the deviated nasal septum. Once nasal septum surgery had been done, dissection was then done and the nasal bridge was augmented with the costochondral graft. A strut graft was then placed to elevate the left nostril. Scar revision surgery followed with excision of scar tissue from the upper lip. Closure was then done intranasally using resorbable sutures and extraorally using non-resorbable sutures. Complete patient satisfaction at the outcome of the surgery The patient and his parents were very happy with the results of the surgery. The patient now had a sharp, symmetrical and prominent nose after the cleft rhinoplasty. Upper lip scar revision surgery also enhanced the esthetics of the patient’s face. He expressed his joy to the surgeon and mentioned that this will help him to lead a life with more confidence. Surgery Video
Cleft nose surgery with lip revision
Patient born with a unilateral cleft lip and palate The patient is a 28-year-old male from Nashik in Maharashtra, India who was born with a cleft lip and palate. These are the two most common birth defects found in newborns. Speech development is also affected by these defects. Breathing problems can also be associated with them. The surgical procedures require extreme precision and dexterity for successful esthetic outcomes. He had undergone cleft lip surgery at 3 months of age and cleft palate surgery at 9 months of age by a cleft team. The hole in the roof of the mouth had been closed. Both surgeries had been performed elsewhere. However, the patient’s nose had become progressively deformed as he grew up. It was flat and crooked and the patient felt that it made him unattractive. This had become more and more noticeable with the passing years. Social problems arising from the presence of the scars There was also a very prominent scar from the cleft lip surgery. This had caused a great deal of distress to the patient and had made the patient an introvert. He rarely left the house and had few friends. There had also been instances of bullying at school and college. His lip and nose deformities played on his mind. He wanted to undergo cosmetic surgery for surgical repair of his nose and lip. The patient had consulted cosmetic surgeons and plastic surgeons in his hometown who had examined the patient. Realizing the degree of correction required, he had referred the patient to our hospital for rhinoplasty and lip revision surgery. A rhinoplasty is commonly referred to as a nose job. Center of excellence for cosmetic nose surgery Our hospital is a specialty center for cosmetic rhinoplasty. All forms of nasal deformities are corrected surgically at our hospital. Bone grafts are used to address many of these procedures. Even many celebrities have undergone cosmetic nose surgery here. Subtle changes in the form of their nose even gave some of them a new lease in their career. Initial examination and treatment planning at our hospital Dr SM Balaji, cosmetic nose surgeon, examined the patient and and ordered comprehensive imaging studies. The patient stated that he wanted a sharp, prominent and symmetrical nose. He also stated that he was very self conscious about the residual scar from his cleft lip surgery. There was loss of mustache from the philtrum. The patient also requested scar revision surgery. Lip revision followed by nose correction with costochondral rib graft was planned for the patient. Right lateral osteotomy was also planned to correct the nasal deformity. The patient was scheduled for cleft nose surgery with lip revision. Successful surgical correction of deformed nose and lip Under general anesthesia, the lip revision surgery was performed first with excision of the residual scar tissue. Following this, an incision was made in the right inframammary region and a costochondral rib graft was harvested. A transcartilagenous incision was next made in the right nostril with dissection done up to the nasal dorsum. The nasal dorsum was augmented using the costochondral graft. A right lateral osteotomy was then done followed by placement of resorbable sutures intranasally. Total patient satisfaction at the outcome of the surgery The patient was extremely happy with the results of the surgery. His nasal asymmetry had been corrected and there was perfect harmony with the rest of the face. He no longer had a depressed or crooked nasal form. His nose was symmetrical, elevated and prominent. The scar revision was also successful. He stated that he can now face life with confidence with the correction of his nasal and lip deformities. This would also help him be less introverted and develop an active social life. Surgery Video
Cleft Rhinoplasty with dental implant
Patient born with unilateral cleft lip and palate The patient is a 25-year-old female from Ongole in Andhra Pradesh, India. She was born with a unilateral cleft lip and palate. Her parents had been advised that she needed to undergo cleft lip repair at 3 months and cleft palate surgery at 8 months of age. The hole in the roof of her mouth was successfully closed through cleft palate repair. She had subsequently undergone both surgeries at a local hospital. A cleft alveolus reconstruction had been performed at 4 years of age. This is the correct recommended timetable to undergo surgery for these congenital defects. Teeth can be missing in the region of the cleft in the alveolus. These are replaced through the use of artificial teeth attached to implants. Meticulous gum tissue health is necessary for success of implants. Dissatisfaction with appearance while growing up The patient developed a flat and bulky nose over time. She also had a very prominent scar from her cleft lip surgery. This had made her feel very self conscious. Her self confidence level was also low because of her facial deformities. She had always desired to have a sharp prominent nose. The nose consists of both bone and cartilage tissue. The patient and her parents had visited a local cosmetic surgeon who examined her. Realizing the extent of correction required, he had referred them to our hospital. Our hospital is a premier center for cosmetic nose surgery in India. Results over the years stand testimony to the level of care at our hospital for cosmetic rhinoplasty. Initial presentation at our hospital for management Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained relevant diagnostic imaging studies. The patient’s chief complaint was a depressed nose and lip scar. Columellar collapse had resulted in the depressed nose. She also complained of mobility of her upper front teeth. This was found to be retained deciduous lateral incisors. The patient stated that her nose looked bulky and this made her feel uncomfortable. She requested for a symmetrical nose with prominent tip. The patient was also found to have a depressed left anterior maxilla. Treatment planning formulated and explained to the patient A complete treatment plan was formulated for the patient. It was decided to extract the mobile retained deciduous lateral incisors. This would be replaced with dental implants. It was also decided to augment the left anterior maxillary defect with a rib graft. This would result in elevation of the base of the nose. Our hospital is a specialty center for cosmetic surgery procedures. A costochondral graft would then be used to perform nose correction of the depressed bridge. This would give the patient a prominent bridge of the nose. The patient consented for cleft rhinoplasty with dental implant surgery. Successful surgical correction of the patient’s complaints Under general anesthesia, an incision was made in the right inframammary region. Dissection was carried down to the ribs. A costochondral rib graft was then harvested. This was followed by a Valsalva maneuver to ascertain that there was no perforation into the thoracic cavity. The wound was then closed in layers with sutures. Attention was then turned to lip scar revision surgery. Once this had been successfully performed, the two retained deciduous teeth were extracted. Nobel Biocare dental implants were then placed at the extraction sites. Attention was then turned to the depressed region of the left anterior maxilla. A flap was elevated and the area was augmented using the rib graft. The graft was then fixed using titanium screws. This would slowly integrate with the maxillary bone over time to form a defect free maxilla. A transcartilagenous incision was next made in the right nostril. Dissection was then done down to the lateral nasal cartilages, which were excised. Following this, the nasal dorsum was augmented using the costochondral rib graft. This resulted in a prominent sharp nose for the patient. Patient satisfaction at the results of the surgery Cosmetic improvement from the surgery was immediate. The patient was very happy with the outcome of the surgery. She now had a symmetrical and prominent nose without the lip scar. Her parents also expressed their happiness at the results of the surgery. Surgery Video
Cleft Rhinoplasty Alar web Removal and Dorsal Augmentation Surgery
Patient born with unilateral cleft lip and palate The patient is a 19-year-old female from Firozpur in Punjab, India, born with a left-sided unilateral cleft lip and palate. A cleft palate is an incompletely fused roof of the mouth. She had undergone cleft lip repair at 4 months of age and cleft palate repair at 9 months of age. This had been followed by cleft alveolus reconstruction at 4 years of age. All these surgeries had been performed at a local hospital by an oral and maxillofacial surgeon. Surgical correction of these deformities is through oral and maxillofacial surgery. Experienced plastic surgeons also perform this surgery. Perfect alignment of many layers of skin and tissue are involved in this surgery. Surgery for removal of hypertrophic scar tissue might be needed at a later date. Bone grafts will be needed in case of bone deficiency in the alveolar region of the cleft. Speech therapy will be needed for normal development of speech. Normal speech development is very important for proper integration into society. The patient had developed a retruded maxilla as she grew up as well as a nasal deformity. This had made her feel very self conscious and she had always kept to herself with very few friends. She had also faced a lot of bullying at school. Bullying by peers can cause a lot of psychological scars in children with congenital deformity. This is more so in the case of cleft lip and palate as it is on the face. Her worried parents had consulted again with the oral and maxillofacial surgeon who referred them to our hospital. Initial presentation at our hospital in 2018 The patient and her parents initially presented to our hospital in 2018. Dr SM Balaji, rhinoplasty surgeon, had examined the patient and obtained a detailed history. He then ordered for detailed imaging studies, which revealed the retruded maxilla. The patient also had a nose that was depressed on the left side. There was also an ungainly scar with alar webbing on her upper lip from the previous surgery. The patient and her parents wanted correction of the above defects along with creation of a symmetrical nose and scar removal. Treatment planning included Le Fort I correction of her retruded maxilla followed by scar revision surgery of her upper lip. A rhinoplasty surgery was also planned for the nasal deformity correction. She underwent Le Fort I advancement of the maxilla at the time of her initial presentation to our hospital in 2018. She now presents with her parents for rhinoplasty and scar revision surgery. Treatment planning for rhinoplasty and scar revision surgery Examination revealed that the patient had an unsightly scar from her previous cleft lip surgery. There was also a nasal deformity with a depressed left nostril, which was considerably smaller in size than the right nostril. Left nasal sill correction and nose correction with costochondral graft was planned. Alar web correction was also planned on the left side. Surgical correction of the patient’s facial deformities Under general anesthesia, an incision was made in the right inframammary region and a costochondral rib graft was harvested. A Valsalva maneuver was performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Following this, a sulcular incision was made in the left anterior maxilla and a flap was elevated. The previously placed titanium plate and screws were removed. Left anterior maxilla was then augmented using the rib graft, which was fixed using titanium screws. Left nasal sill correction was next performed followed by closure of the incision with sutures. A transcartilagenous incision was then placed in the right nostril with dissection up to the dorsum of the nose. The nasal dorsum was augmented using the costochondral graft. A strut graft was then placed. This was followed by closure using resorbable sutures intraorally and intranasally. Successful correction of the patient’s complaints through surgery The patient and her parents were extremely happy with the results of the surgery. There was tremendous improvement in the esthetics of her face. She now had a nose that was symmetrical and in harmony with her face. The patient expressed that she could now face the world with a renewed sense of confidence. Surgery Video
Cleft Rhinoplasty – Nasal Augmentation and Creating Symmetry
Patient born with right sided cleft lip and palate The patient is an 18-year-old female from Jhansi in Uttar Pradesh, India who was born with a right sided unilateral cleft lip and palate. Cleft lip is the presence of a gap in between the two halves of the upper lip. This is a developmental defect that happens in utero. Repair of cleft lip involves perfect integration of layers of skin and muscle tissues. A cleft palate is incomplete fusion of the roof of the mouth. Cleft palate repair would result in closure of this defect. She had undergone cleft lip surgery at 3 months of age, cleft palate surgery at 8 months of age and cleft alveolus reconstruction at 4 years of age. All these surgeries had been performed by an oral surgeon at a local hospital. Cosmetic and functional complications arising from surgery The patient had developed an asymmetrical depressed nose along with hypertrophic scar from the cleft lip repair surgery. She had faced a lot of bullying in school and had always been a socially withdrawn person with few friends. The patient had become depressed of late and had begun to isolate herself inside the house. Her worried parents visited the oral surgeon who had referred her to our hospital for surgical correction of her deformities. The patient wished to have a symmetrical nose along with removal of the scar from the upper lip. Social difficulties face by children with cleft lip and palate Children born with cleft lip and palate deformity can face a lot of social difficulties. Bullying by peers is one of them. This usually occurs in the school setting. This is a result of these children being perceived as being different by other children. Parents have to be very sensitive and understanding while addressing these issues. Improper handling at this stage can lead to lifelong psychological scarring in these children. Initial presentation at our hospital with treatment planning Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient and ordered comprehensive imaging studies. The patient had a unilateral cleft lip on the right side, which had caused the right side of the nose to become depressed. The right nostril was considerably smaller in size than the left nostril. There was also a noticeable scar near the right nasal sill. Treatment planning of nasal asymmetry and scar revision Rhinoplasty surgery would be required for correction of the nasal asymmetry. A rhinoplasty is also known as the nose job. Correction of the nasal defect was planned through the use of a costochondral graft harvested from the patient. The nasal bridge was to be elevated using the costochondral graft. A strut graft would be used to correct the depressed right nostril. Revision of the scar from the cleft lip repair surgery was also planned for the patient. This was explained to the patient and her parents who consented to surgery. Successful surgical correction of the patient’s complaints Under general anesthesia, an incision was made in the right inframammary region and a costochondral rib graft was harvested. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Scar revision surgery was next performed with the scar near the right nasal sill being excised. A transcartilagenous incision was next placed in the left nostril and dissection done up to the dorsum of the nose. The nasal dorsum was augmented using the costochondral graft. A strut graft was then utilized to elevate the depressed right nostril. Closure was then done using resorbable sutures both intranasally and extraorally. Complete patient satisfaction at the outcome of the surgery The surgery was a success with a resultant symmetrical nose along with excision of the scar from the sill of the nose. Esthetic improvement of the patient’s face was immediate. The patient and her parents expressed complete satisfaction at the outcome of the surgery. The patient now had a more symmetrical nose, which was in harmony with the rest of her face. She expressed her joy and sincere gratitude to the surgeon. She was no longer afraid of fellow students teasing her. She will now be able to lead a normal life with more self-confidence. Surgery Video
Simultaneous Alveolar Bone Graft and Cleft Rhinoplasty Surgery
[et_pb_section admin_label=”section”] [et_pb_row admin_label=”row”] [et_pb_column type=”4_4″][et_pb_text admin_label=”Text”] Classification of cleft lip and palate surgery Surgery for the correction of a cleft lip and palate comes under both functional as well as cosmetic surgery. Other cosmetic procedures include face lifts, tummy tucks, removal of signs of aging such as wrinkling of skin, other forms of skin care surgery such as removal of warts and scars, brow lift and eyelid surgery. Wrinkling of skin is a sign of ageing. This is a physiological process and happens with due course of time. Premature wrinkling can lead to loss of confidence in a person. This can be corrected by tightening the skin by pulling it near the jaw line. An experienced surgeon is needed to perform this to perfection as it may lead to a mask like appearance of the face if done incorrectly. Facial lifts are performed this way. All these come under facial plastic surgery. Bilateral cleft lip and palate surgery is the most severe form of cleft. Correction of cleft lip and palate deformity is performed by an oral and maxillofacial surgeon. Board certified plastic surgeons also perform these above mentioned surgeries in the developed nations of the world. Patient with a history of unilateral cleft lip and palate The patient is a 25-year-old male from Ranchi in Jharkhand, India who was born with a unilateral cleft lip and palate deformity. He had undergone cleft lip surgery at the age of 3 months and cleft palate surgery at the age of 9 months. Pharyngoplasty had been performed at the age of 3-1/2 years to improve his speech and correct his velopharyngeal insufficiency. Alveolar cleft defect reconstruction was done at the age of 4 years. All the surgeries were done elsewhere. The patient has always had a nasal deformity due to his cleft, which has always made him feel very self conscious. He had always been a loner because of this and has few friends. His worried parents had consulted a doctor in their hometown who advised them to get this corrected surgically. He had then referred the patient to us as our hospital is renowned for cleft rhinoplasty surgery. Our hospital is a premier center for all varieties of facial cosmetic surgery in India. Initial presentation and examination at our hospital Dr SM Balaji, facial cosmetic surgeon, examined the patient and ordered comprehensive imaging studies. Imaging studies revealed a noticeable depression in the right anterior maxillary region. Since the patient is a case of unilateral cleft on the right side, the right side of the nose was depressed along with a depressed nasal bridge. The right nostril was also depressed. It was explained to the patient that the depression in the right maxilla needed to be corrected with placement of a rib graft along with a costochondral graft for nose correction. The right anterior maxillary graft would add bulk to the lip contour thus elevating the base of the nose. A lip revision and Weir excision was also planned for the patient. Successful surgical correction of the nasal deformity Under general anesthesia, an incision was first placed in the right inframammary region and a costochondral rib graft was harvested. This was followed by a Valsalva maneuver, which demonstrated a patent thoracic cavity without any perforations. The incision was then closed in layers. Following this, a sulcular incision placed in the right anterior maxilla and a flap was elevated. A rib graft was crafted to fit into the defect in the right anterior maxilla. This was then fixed in place using titanium screws. Next, a transcartilaginous incision was made in the left nostril and dissection was done up to the dorsum of the nose. Following this, the nasal bridge was then augmented using a costochondral rib graft. A strut graft was also placed to elevate the right nostril. This was then followed by lip revision surgery with Weir excision done on the left side. Full patient satisfaction at the results of the surgery The patient was very satisfied with the results of the surgery. He expressed his happiness at the cosmetic outcome of the surgery. His parents expressed their thankfulness to the surgical team, saying that this would enable the patient to lead a normal life. Surgery Video [/et_pb_text][/et_pb_column] [/et_pb_row] [/et_pb_section]
Unilateral Cleft Nose Rhinoplasty Surgery
Etiology behind cleft lip and palate deformities Cleft lip and palate deformities are the result of the breakdown of normal mechanisms that are behind the formation of the face in utero. The incidence of this deformity varies between races, geographical locations and socioeconomic backgrounds. These can manifest as just a simple notching in the lips to complete clefting of the lip, alveolus and palate. Treatment approaches also vary according to the severity of the deformity. There is a very strong genetic basis to the formation of cleft lip and palate. Environmental factors can also play a role in the appearance of this deformity. A great deal of time and money is being invested around the world to identify the genes responsible for cleft formation; however, this is easier said than done as this involves a complex interplay of various genes. Environmental factors too play a big role in the formation of clefts. These include exposure to industrial solvents, abuse of drugs such as methamphetamines and cocaine during pregnancy, exposure to tobacco smoke and also ingestion of certain pharmaceutical drugs during pregnancy. Patient born with a unilateral cleft lip and palate This 25-year-old patient from Asansol in West Bengal, India was born with a unilateral cleft lip and palate. He always felt that his nose looked ugly and was very conscious because of that. He stated that he always preferred to be alone because of his nasal deformity. The patient said that he always wanted a normal looking nose with a prominent tip. He also complained of a residual scar in the upper lip from his previous surgery where there was no hair growth. Previous history of surgical correction The patient had previously undergone cleft lip surgery at around 3 months of age followed later by cleft palate repair along with palatoplasty as an infant elsewhere. Cleft alveolus reconstruction surgery had been done at the same hospital at the age of 4 years. He had also undergone rhinoplasty with nasal reconstruction through bone grafting elsewhere about one year ago. The roof of the mouth had been adequately repaired followed these surgical repairs. This surgical procedure is commonly performed by plastic surgeons in specialty children’s hospitals in the Western countries. Many patients with cleft palate deformity develop speech problems and need long term speech therapy for normal speech development. Referral to our hospital for nasal deformity correction The patient desired to undergo nasal defect correction surgery as well as scar removal surgery as he felt they would dramatically improve the quality of his life and make him more self confident. He approached a local oral surgeon who felt that the patient needed to undergo surgery at a specialty center for rhinoplasty surgery. The patient was thus referred to our hospital as we are a renowned for cleft rhinoplasty surgery in India. Initial examination and treatment planning Dr SM Balaji, specialist in cleft lip surgery and cleft palate surgery examined the patient thoroughly and went over his previous medical records. The patient’s unilateral cleft on the left side had left his nose depressed. There was also a considerable size discrepancy between the size of the nostrils with a smaller left nostril. A noticeable depression in the left anterior maxillary region also added to the nasal deformity. The scar near the philtrum was devoid of any hair growth. It was explained to the patient that he needed a lip revision surgery followed by augmentation of the left anterior maxillary region and nose correction with costochondral rib grafts. Augmentation of the left anterior maxilla would elevate the base of the nose leading to considerable cosmetic improvement. Surgical correction of nasal deformity Under general anesthesia, an incision was first made in the right inframammary region and costochondral rib grafts were then harvested. A Valsalva maneuver confirmed that there was no perforation into the thoracic cavity following which the incision was then closed in layers. Attention was next turned to the lip scar revision surgery. The scar tissue along the philtrum was excised completely and the skin edges were approximated using fine sutures. This was followed by a sulcular incision in the left anterior maxillary region. A flap was then elevated and the left anterior maxilla was augmented using rib grafts, which were fixed using titanium screws. Next, a transcartilaginous incision was placed in the right nostril, dissection was performed, and a strut graft was placed to elevate the left nostril. Patient expresses satisfaction at surgical outcome The patient was extremely happy with the results of the surgery. He now had a more symmetrical and prominent nose. There was also complete removal of the scar on the lip. He expressed complete satisfaction before final discharge from the hospital. Surgery Video
Oblique Facial Cleft Secondary Rhinoplasty Surgery
The varying degrees of facial clefting Facial clefts are deformities of the face that are very rare and involve malformation of a part of the face. The etiology of facial clefts is still unclear though it is thought to be caused by failure of the fusion process during the development of the face. Genetics too is thought to play a role in the occurrence of facial clefts as the incidence of parents with facial clefts having children with facial clefts is quite high. There have also been instances where facial clefts have occurred in children with no family history of facial clefting. Facial clefting was studied in depth by Dr Paul Tessier who came up with the first classification of facial clefting. Dr. Paul Tessier is also considered to be the father of craniofacial surgery. Tessier’s classification of facial clefts ranges from 0-14. For example, Tessier cleft 0 bisects the maxilla and the nose. Children with these deformities would need multiple surgical procedures for rehabilitation of the defects. Patient born with cleft deformity and proboscis lateralis The patient is a 14-year-old boy from near New Delhi, India who was born with a cleft defect and proboscis lateralis. This involved gross deformity of the soft tissues of the nose. He was operated by a board certified plastic surgeon in Delhi shortly after birth for the cleft defect along with primary correction for proboscis lateralis. Cleft alveolar reconstruction/alveolar cleft defect reconstruction was also performed at the same hospital before he completed one year; however, the results of the plastic surgery were unsatisfactory and the patient has always been depressed about his facial deformities. What is proboscis lateralis? Proboscis lateralis is a congenital facial abnormality that is characterized by the presence of an incompletely formed rudimentary nasal appendage that is found in association with cleft lip defects. It is located off center to the vertical midline of the face. It is usually attached at the inner canthus of the eye and often associated with maldevelopment of the nasal cavity or paranasal sinuses of the affected side. Proboscis Lateralis is also associated with other craniofacial abnormalities such as orbital anomalies, cleft lip/palate, frontal encephalocele, and holoprosencephaly. Parents seek surgical correction of the nasal deformity Seeing how this was affecting their son’s life, the parents took him to Kolkota for consultation with a plastic surgeon. After a thorough examination, the plastic surgeon explained to the parents that this was a complex deformity that had to be addressed by a maxillofacial surgeon who was also a facial cosmetic surgery specialist. It was explained to the parents and the patient that the surgery procedures that he would need would include reconstructive surgery and cosmetic procedures for nose reshaping. He then referred the patient to our hospital for surgical correction of his problem. Our hospital is renowned for cosmetic nose surgery in India. Patient presents to our hospital for treatment Dr SM Balaji examined the patient and ordered comprehensive imaging studies. A 3D CT scan was obtained to fully evaluate the extent of the defect. Clinical examination revealed that the patient had a depressed nasal bridge with a deformed nose. His right nostril was smaller in size. Treatment planning was formulated and explained to the patient. Rhinoplasty or nose job would be performed to correct the patient’s nasal defect. The nasal defect was planned to be repaired using a double decker rib graft, which would be held in place using wires. Size of the right nostril would also be increased by means of a triangular flap along with a Wier excision. Surgical correction of the patient’s nasal deformity Under general anesthesia, rib grafts were first harvested through a right inframammary incision. This was followed by a Valsalva maneuver to ensure that there was no perforation of the thoracic cavity. The incision was then closed in layers. A midline nasal incision was then made and dissection was done up to the dorsum of the nose. The nasal bridge was then augmented using a rib graft followed by placement of a strut graft. A Wier excision was done on the right side. A triangular flap was raised from the right nasolabial region to increase the right nostril size following which the incision was closed with sutures. The patient and his parents were extremely happy with the results of the surgery and expressed their complete satisfaction before final discharge from the hospital. Surgery Video