Cleft lip nose tip deformity: a tutorial dissertation.

Rhinoplasty in the cleft lip nose is complicated because of the many features that go to make up a typical cleft deformity. The main problems that need to be considered are as follows: 1. The tip is deflected away from the cleft side. 2. The alar dome on the cleft side is depressed. 3. The ala is flat and buckled. 4. There is an absent alar/facial groove. 5. The nostrils are wide on the cleft side. 6. There is an increased nostril circumference. 7. The nares lie in a caudal position. 8. The columella is short on the cleft side. 9. The columella is also oblique. 10. There may be a bowstring contracture of the internal nares. 11. The bony base of the ala is deficient. There are probably as many methods employed to correct these deformities as there are surgeons performing the operations. In general however, it is usual to begin with a conventional rhinoplasty in which the nasal hump is reduced and the nasal bones infractured. This will reduce the bridge of the nose, but will do nothing to correct the major problems of the cleft lip tip, and for this, it is essential to have a wide variety of methods available to suit every particular case. In general terms, the methods can be grouped under the following headings: 1.