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Primary Rhinoplasty in Unilateral Cleft Patients: The “Limited Open” Approach and Other Technical Considerations

Objective To validate a method of primary anatomic alar repositioning using a “limited open rhinoplasty” approach, along with cleft lip repair, without presurgical orthopedics. Methods The cleft lip deformities were repaired using a modified Tennison technique, and primary muscle union and gingivoperiosteoplasty were achieved in all cases. The alar cartilages were visualized using an inverted “U” incision on the cleft side and a rim incision on the noncleft side, without joining the two with a transcolumellar incision. The domes of the cartilages were approximated by a single horizontal mattress suture. Patients Thirty-five patients were operated on by this technique between March 1999 and February 2004. The patients ranged in age from 4 to 36 months (mean, 6 months). The follow-up ranged from 4 months to 4.5 years (mean, 18 months). Results Overall, the results for nasal shape and symmetry have been extremely good. Conclusions The technique used here provides an exposure just short of an “open” rhinoplasty without scarring the columella or nasal tip. Arch alignment and a symmetric and stable bony platform are generally achieved by 2 to 3 months after the surgery. In severe cases of complete clefts, we have observed an absolute increase in alar arch length as a result of tissue stretch.