ABSTRACT
Despite multiple descriptions of techniques for primary cleft lip/nose repair in the literature, consensus on optimal management among experienced cleft surgeons remains elusive. Within the literature, three main philosophies of approach to the primary cleft nasal deformity could be described. This chapter focuses on technical aspects of an intermediate surgical philosophy and highlights aspects of the alternate philosophies where relevant. Various methods and approaches have been described for primary rhinoplasty performed at the time of lip repair. However, there is a growing consensus that primary rhinoplasty should and can be performed without additional scarring or incisions beyond those required for concurrent repair of the cleft lip. Ongoing nasal asymmetry is common in children with cleft lip and palate (particularly unilateral). The reasons for the asymmetry are well recognised and could be considered as a combination of skeletal, cartilaginous and soft tissue.
