Patterns and management of congenital nasal clefts

Abstract

Objective The aim of the study was to study different patterns of congenital nasal clefts and different methods of their management trying to put forward a road map for their treatment. Background Because of the rarity of atypical facial clefts, little is written with respect to patterns and plans of management. This study will spot light on atypical facial clefts affecting the nose (atypical nasal clefts) with respect to different patterns and plans of management. Patients and methods This was a retrospective and short prospective study that was conducted in the Department of Plastic Surgery, Menoufia University, from 2001 to 2014. The study included 26 patients with atypical nasal clefts. Those patients were classified according to Tessier classification into Tessier type 0, 1, 2, and 3. All patients were evaluated for the type of facial clefts, pattern of nasal involvement, and associated congenital anomalies. In all, 20 of them underwent surgical repair in one or more stages according to complexity of the deformity. The study describes different plans of reconstruction used for management. Results The statistical analysis of data was descriptive and focused on description of different patterns of Tessier type. It showed that the highest incidence was Tessier 0, which included 17 cases found in eight patterns, followed by five cases in Tessier 1 in three patterns, two cases in Tessier type 2 in two different patterns, and two cases in Tessier type 3 in two patterns. The analysis of data showed that the most common associated congenital anomalies were cleft lip and hypertelorism. With respect to management, analysis of data showed the variation in number of operations, timing of first operation, and type of surgical intervention according to complexity and pattern of deformity. Conclusion Atypical nasal clefts can be found in a very wide range of patterns, ranging from simple esthetic deformity to complete agenesis or bifidity of the nose. Management of these cases requires good analysis of the pattern of nasal cleft and we provided a treatment algorithm for each pattern.