ABSTRACT
Despite all the improvements in primary cleft surgery, cleft nasal deformity still remains a functional and aesthetic dilemma for patients and surgeons. There is inherent composite tissue abnormality or hypoplasia. The developmental problems therefore can be divided into the following three categories: the covering, the framework (bone and cartilage) and the lining. Alveolar cleft, hypoplasia and retroposition of the maxilla compound the nasal deformity. The chapter considers four stages of cleft rhinoplasty: rhinoplasty procedures at the time of primary cleft lip surgery; cleft rhinoplasty during the pre-school years; cleft rhinoplasty once growth has stopped; and definitive rhinoplasty. Although hump reduction is rare, infracture of the nasal bone is still carried out as it allows narrowing of the nasal bridge. The bilateral cleft lip nasal deformity presents with a shortened columella. Nasal tip projection can be increased with a columellar strut and this can be further reinforced with extended septal graft if needed.
