Esthetic evaluation of early rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding

Abstract

Background: The aesthetic outcome of primary rhinoplasty with complete unilateral cleft lip repair is a challenging due to nasal deformities, tissue deficiencies and alveolar ridge displacement. The aim of this study is aesthetic evaluation of primary rhinoplasty with complete unilateral cleft lip repair after nasoalveolar molding (NAM). Patient and methods: The study was applied on 30 patients with complete unilateral cleft lip, mean age at presentation was 89.17± 73.02 days (range 15-260 days). Presurgical nasoalveolar molding (PNAM) was done for all patients with mean duration of molding 78.48± 5.635 days (range 66-87 days). Measurements of nose and alveolar defect were taken by caliper before application of the device and after application of the device and after one month of operation and compared with each other’s. All patients were subjected to lip repair with Millard technique with primary closed rhinoplasty. Primary rhinoplasty with cleft lip repair becomes easier since NAM diminishes the tension over the soft tissues and reduces severity of deformity in the lower lateral alar cartilages. Postoperative nasal stent has a great role in improve the esthetic outcome of primary rhinoplasty. Results: There were significant improvement of nasal symmetry and reduction of alveolar gap width (AGW) after use of NAM. Conclusion: This study suggests that PNAM within 15 days post-delivery is effective at reducing alveolar gap width, alignment of cleft alveolar segments and improvement of nasal symmetry as long as the parents cooperate in placing and maintaining the NAM device in the newborn’s mouth and nose.