Cleft Rhinoplasty – Nose Correction Surgery
Different nasal forms and the human face The nose is the most prominent feature in the human face. Evolution down the ages had resulted in a wide variation to human facial features. This ranges from the color of the skin to the shape of the nose or the shape of the chin being different although the DNA is the same. Environmental factors, diet and a few other factors had influenced this. For example, people from very cold places that received very little sunlight developed light skin and aquiline noses. This served an evolutionary function as less body heat was lost through lighter skin and passage of cold air breathed in through long noses resulted in adequate humidification and warming up of the air as it passed into the trachea. Likewise, people in hotter regions of the earth developed darker skin and noses with wide open nostrils. This enabled easier cooling down of the body as well as cooling down of the air as it passed in through the broader nostrils. Functional versus cosmetic rhinoplasty Functional rhinoplasty is performed when the patient is having problems with breathing or if the deformity of the nose is to a degree that it is affecting their normal functioning in society. This can range from anything from a deviated nasal septum to reconstruction of the nose affected by a cleft lip deformity. A functional rhinoplasty correction also invariably results in improvement in the cosmetic appearance of the nose. Cosmetic rhinoplasty is performed when the patient has no functional difficulties, but is simply dissatisfied with the appearance of the nose. This is a completely elective procedure and is performed by either plastic surgeons or oral and maxillofacial surgeons. Surgeons from both these specialties undergo years of extensive training in this procedure. Young woman with a previous history of cleft lip and palate repair The patient is a young woman from Jharkhand who had undergone repair of her cleft lip and palate as an infant. She had however always had a nasal deformity with a flattened bridge of the nose and a collapsed columella. She had also had nasal breathing problems and snoring during sleep. She desired to undergo cosmetic surgery by a facial plastic surgeon to correct this. This variety of plastic surgery is also performed by oral and maxillofacial surgeons. Cleft rhinoplasty elsewhere with unsatisfactory results from the surgery She underwent a rhinoplasty elsewhere two years ago, but was very unhappy with the results of the previous rhinoplasty. She felt that the bone grafting to augment the bridge of her nose was too bulky and her breathing difficulties had worsened. Bone grafting had also been performed to a bony deficiency in the left anterior alveolar region. Patient referred to our hospital for revision rhinoplasty surgery She and her parents presented to a local plastic surgeon who advised revision cleft rhinoplasty surgery to correct her problem. He referred them to our hospital as this required a redo rhinoplasty surgery. This redo rhinoplasty required advanced techniques as the primary rhinoplasty procedure had been improperly performed. The graft placed in the previous surgery had to be removed followed by placement of a newly harvested bone graft. This rhinoplasty procedure is best performed by an experienced rhinoplasty surgeon. It is only board certified oral and maxillofacial surgeons who perform this surgery in developed countries like the US, UK, Germany and Japan. The nasal bones could have been deformed by the previous surgery. Formation of excess scar tissue could cause this sort of deformity. The nose had to be brought into perfect alignment with the facial features. Initial examination and treatment planning of the patient They presented for consultation with Dr SM Balaji, rhinoplasty specialist, who examined the patient and ordered imaging studies. This revealed that the patient had a collapsed columella and the graft at the augmented bridge of the nose had shifted. Merits of an open rhinoplasty versus closed rhinoplasty were considered for the patient. He explained to the patient and the parents that he needed to harvest new bone grafts to correct this deformity. The patient and her parents were in agreement with the treatment plan and consented to surgery. Harvesting costochondral rib grafts for the surgery Under general anesthesia, an incision was made through the old scar from the site of the previous bone graft. Two costochondral rib grafts were harvested and a Valsalva maneuver was performed to ensure patency of the thoracic cavity. The incision was closed in layers after confirming this. Cleft rhinoplasty with placement of columellar strut graft Attention was next turned to the revision cleft rhinoplasty nose surgery. A vestibular incision was made in the anterior maxilla and the bone graft used to augment the bony depression in the anterior maxilla was exposed. The titanium screw used to fix the screw was removed and the region was further augmented with a rib graft shaped to fill the bony depression in the region. Attention was next turned to the revision rhinoplasty portion of the procedure. The costochondral grafts were contoured to the correct shape. The previously placed rib graft was removed. An intranasal incision was then made and a graft was tunneled in to give perfect form to the bridge of the nose. The second costochondral rib graft was then used as a strut graft to raise up the collapsed columella. This was tunneled into the columella through an intraoral approach and secured in place with sutures. This gave perfect form and symmetry to the nose. The vestibular incision was then closed with sutures and the patient extubated from general anesthesia. Patient and her parents expressed complete satisfaction at the results from the surgery before final discharge from the hospital. Surgery Video
Unilateral Cleft Lip & Palate Rhinoplasty Surgery
Patient presents to our hospital for nose asymmetry correction The patient is a young man who had undergone cleft surgery in our hospital as an infant. He now presents for correction of nasal asymmetry and scar revision surgery. Treatment planning explained in detail to the patient Dr SM Balaji examined the patient and explained the treatment planning to him. He explained that harvesting a rib graft was necessary for this surgery. The patient consented to this and agreed to the surgery. Successful rhinoplasty and cleft lip scar revision surgery Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva maneuver was then performed and demonstrated a patent thoracic cavity. The incision was then closed in layers. Attention was next turned to the rhinoplasty surgery. Intranasal incisions ensured absence of visible scar formation. Medial osteotomy of the nasal bone was then done. The spreader graft was then placed. Following this, the rib graft was then shaped and tunneled to the bridge of the nose. This established symmetry of the nose. Attention was next turned to the scar from the previous cleft lip surgery. The scar was then incised and skin edges sutured using fine sutures. The patient expressed his satisfaction at the results before final discharge. Surgery Video
Unilateral Cleft Rhinoplasty Surgery
Rhinoplasty for cleft lip and palate related nasal deformity The patient is a young woman who had been born with a left sided cleft lip and palate. She underwent cleft lip repair surgery elsewhere as an infant. Past surgical history of the patient She has undergone alveolar bone grafting and orthodontic treatment here at our hospital. A LeFort 1 maxillary advancement surgery was also done here. She now presents for rhinoplasty for correction of her nasal deformity. This is her final surgery. Rib grafts used to correct the nasal deformity Under general anesthesia, Dr SM Balaji harvested two costochondral rib grafts. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Rib grafts were then crafted into the right size and shape. Following this, bilateral intranasal incisions were then made. The nasal bone was next fractured and then set right to correct the deviation in the nasal septum. The cartilaginous grafts were next positioned through the incisions and stabilized with sutures. This resulted in reestablishment of nasal symmetry. The patient and her parents were very happy with the results of the surgery. They expressed this to Dr SM Balaji before discharge from the hospital. Surgery Video
Cleft Rhinoplasty Depressed Alar Cartilage Correction Surgery
Patient with collapsed left ala seeks best rhinoplasty surgeon The patient is a young woman from West Bengal. She had been born with a cleft lip and palate and had undergone repair of her cleft lip and palate as an infant. The patient has a collapsed left ala of the nose. This has led to asymmetry of her face, which she wants corrected now. Her parents searched far and wide for the best rhinoplasty surgeon in India. Their search finally led them to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Treatment plan explained to the patient Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient. He ordered imaging studies to assess the patient. Once he had decided on a treatment plan, he explained it to the patient and her parents. They were in complete agreement with his treatment plan. Surgical rhinoplasty correction for collapsed left ala Under general anesthesia, cartilaginous rib grafts were first harvested from the patient. A Valsalva maneuver confirmed absence of perforation into the thoracic cavity. Attention was next turned to the maxillary bony deficiency. Two rib grafts were then crafted to fit into the deficiency. Screws were then used to fix the grafts into the areas of bony deficiency. Attention was next turned to setting right the collapsed left nasal ala. All incisions were intranasal to avoid scarring. The cartilaginous graft was then shaped to fit into the collapsed ala and then inserted into the ala. This lifted up the collapsed ala and there was restoration of facial asymmetry. All incisions were then closed with sutures. The patient and her parents expressed their complete satisfaction before final discharge.
Re-alveolar bone graft Surgery, Fistula Closure and Cleft Rhinoplasty Surgery
[et_pb_section fb_built=”1″ _builder_version=”3.22″][et_pb_row _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”]This young girl had been born with a left-sided cleft lip, alveolus, and palate. She had undergone repair of her cleft lip as an infant with an alveolar rib graft, but the graft hadn’t fused with the bone and had been a failure. She had developed an asymmetry of her nose because of this and a deficiency in the development of the cartilaginous part of her columella, which had lead to a collapsed left nostril. This had made her very quiet and withdrawn, isolating herself from her peers at school. The alveolar cleft in the region of her left lateral incisor was causing a direct communication with her nasal cavity through an oronasal fistula, which was leading to regurgitation of fluids from her mouth into her nasal cavity. Her parents had been enquiring everywhere as to where her defect would be best set right and had finally been referred to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Dr. S. M. Balaji, Cranio-Maxillofacial Surgeon, examined the patient thoroughly and ordered comprehensive imaging studies including a 3D axial CT scan. He then explained the treatment plan in detail to the parents of the patient and they expressed their desire to go ahead with surgery. After satisfactory induction of general anesthesia, two costochondral rib grafts were obtained from the patient. The wound was then closed in layers after ascertaining patency of the pleural cavity through the positive pressure ventilation test. Following this, mucogingival and palatal flaps were raised on the left side of the patient’s maxillary region at the region of the alveolar cleft defect. Costochondral rib grafts were shaped and crafted to fit into the area of bony defect and fixed with screws. Attention was next turned to the collapsed columella. A costochondral rib graft that had been shaped to precisely fit into the columella was inserted along the length of its base and stabilized in place with sutures. This lifted up the collapsed columella of the nose and set right the deformity to the left nostril. The palatal and the mucogingival flaps were then closed with sutures and the patient recovered uneventfully from general anesthesia. The patient expressed her happiness to Dr. Balaji for setting right the deformity to her nose and her parents expressed their gratitude to Dr. Balaji for enabling an improvement in the aesthetic as well as functional quality of life for the patient. [/et_pb_text][et_pb_video src=”https://www.youtube.com/watch?v=ufiBluI_hic” _builder_version=”4.9.4″ _module_preset=”default”][/et_pb_video][/et_pb_column][/et_pb_row][/et_pb_section]
Cleft Rhinoplasty- Nasal Augmentation and Buckling Correction Surgery
[et_pb_section fb_built=”1″ _builder_version=”3.22″][et_pb_row _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”]The patient is a young girl who was born with a left-sided unilateral cleft lip defect. She was operated upon as an infant at an outside hospital, but that correction had left her with an unsightly residual scar. She had slight lip incompetency on the left side in association with the scar tissue. There was also a buckling of the left nostril. This had lead to taunts and jibes at school from other children, which lead to her becoming withdrawn and quiet. Her worried parents brought her over to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, where she was thoroughly examined by Dr. S. M. Balaji, Cranio-Maxillofacial Surgeon, who suggested a minor scar revision procedure and nasal augmentation with buckling correction surgery. He explained to them that this involved harvesting a costochondral rib graft from the patient to be used to augment the bridge of the nose and her parents were in full agreement with that. Upon induction of adequate general anesthesia, a costochondral rib graft was harvested and the wound was closed in layers with sutures. Following this, the minor scar revision surgery was performed with release of fibrous bands from the scar tissue, which lead to improvement in the patient’s lip incompetency. Next an intranasal incision was made at the region of the lateral crus and a tunnel was created extending up to the bridge of the nose. The cartilaginous rib graft was then manipulated into position resulting in a straighter profile to the nose along with correction of the nasal buckling of the left nostril. The incision was then closed with sutures. The patient was overjoyed at the results of the surgery and couldn’t stop smiling, thanking Dr. Balaji profusely for the way he had set right her problem. [/et_pb_text][et_pb_video _builder_version=”4.9.4″ _module_preset=”default” src=”https://www.youtube.com/watch?v=Lw6nQ_xlrpk” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_video][/et_pb_column][/et_pb_row][/et_pb_section]