Deformity
of nose occurs in varying degrees along with
cleft lips. Although the lip gets corrected
early on in life, the nose deformity persists
as a stigma and it causes mental trauma to the
affected.
The
correction of such deformities is challenging
and the results are rewarding. Nose function
as well as appearance gets major improvement
by surgery. The days are gone when such surgeries
were done in surgical camps. More and more patients
are seeking better care and attention. Restoration
of near normal appearance should be the goal.
The surgical options are many and varied. The
results depend on judicious selection of technique
keeping in mind the nature of deformity. Results
are permanent.
COMPONENTS
OF CLEFT LIP NOSE DEFORMITY.
The
striking features of a cleft lip nose deformity
are: -
1.
The deviation of nasal tip.
2.
Flattening and buckling of the outer wall
of nostril.
3.
Widening of the nostril on the affected
side.
These
are a few other deformities which go along with
these like deviation of the septum, bulbous
tip, excess skin inside the nostril, and low
nasal bridge. The severity of the deformities
varies between different individuals.
TIMING
OF NOSE CORRECTION
The
nose deformity /should be addressed at the time
of cleft lip closure. This is primary nose correction
and gives good results. If the nose was not
corrected early in childhood, the best time
would to do so would be after completion of
facial growth i.e. 14 – 16 years.
METHOD
OF CORRECTION
The
surgical plan depends on the deformity and patients
expectations. The bony and cartilage framework
can be altered to create an aesthetically appealing
nose. Skin excess can be trimmed or readjusted.
Implants
may be employed in selected cases to improve
the profile. The scar on the lip can be improved
upon at the same time. In some cases, the upper
lip needs to be plumped up. This is also done
in the same sitting permanently using the patients
own tissue.
The
surgery is done as a day care procedure and
under general anesthesia.
RECOVERY
TIME
The
nose may be packed with gel foam for two days.
Tapes over the nose come off in 4 days. Swelling
over the nose takes a while to go off. Most
of it resolves in 2-3 weeks.
Length
of stay: Outpatient (home same day).
Before
Surgery Avoid taking aspirin,
Advil, Motrin, or other aspirin-containing
products for two weeks If you are a smoker,
stop smoking to aid in healing.
Discomfort:
Mild to moderate. Anticipate 2-5 days
of prescription pain medication.
Final
result: Will be seen after the
scars have matured, which will be about
six months. Improves over 14 days.
