Secondary unilateral cleft lip nose: the external approach.

No single procedure developed until now has given satisfactory results to provide an ideal surgical method for cleft lip nasal deformity correction. This paper emphasizes the concept that nasal surgery is the end result on an overall treatment program for secondary cleft lip. The first step is correcting skeletal deformities. The second step of modifying the overlying nasal pyramid can only be performed when the alar base and the floor of the nose are at the same level through orthodontic alignment of the maxillary segments and bone grafting. Prior to deciding on the type of strategy, it is essential to carefully analyze the severity of the deformity, the patency of the airways, the nasal lining, and the nasal tip projection. An external approach, using the marginal-transcolumellar incision, provides excellent visualization essential for the accuracy of the correction to be carried out. The technique presented here includes modification of the following points as a single stage operation: septal surgery, suturing the medial crura together, suspension of the alar cartilage to the periosteum of the nasal bone, alar base repositioning, orbicularis muscle suturing, and increasing tip projection.