Debridement of Lower Lateral Cartilages in Cleft Lip–Nose Cases along with Management of Skin and Fibrotic Traction

Rhinoplasties in case of cleft lip–nose and palate are difficult and may include: primary repair of nasal deformities at the time of cleft lip repair; secondary staged repair of cleft lip–nasal deformities; separation of the quadrangular cartilage of the septum from the maxillary crest and securing it to the midline; removal of deviated portions, strut grafts, transplants to project the radix and dorsum, cartilage grafts, multidisciplinary care, etc. Results can vary widely, from excellent in primary corrections to very poor in late surgery cases. In some secondary rhinoplasties, based on skin and fibrotic tractions and deviations, the author offers a more simple method of debridement of the normally formed cartilages. It includes closed approach T-excision with releasing the alar cartilages from their attachments, columella sliding and sutures for stabilization of the columella, nasal tip refinement, dorsal augmentation, and overall symmetry. Such approach could be sufficient in selected cases. In other cases, additional steps may be necessary.