Anatomy of the Bilateral Cleft Lip Nasal Deformity and Its Correction

Anatomy of the Bilateral Cleft Lip Nasal Deformity and Its Correction is organized by American Cleft Palate-Craniofacial Association (ACPA).

Dates:
Original Seminar Date: October 13, 2020
On-Demand Release Date: October 14, 2020
On-Demand Expiration Date: March 31, 2022
Expiration Date: September 13, 2022, 11:55 PM

Description:
The nasal deformity of the bilateral cleft lip is an intrinsic component of the deformity. Uncoupling of the orbicularisoris sphincter results in lateral displacement of the alar bases and protrusion of the premaxilla and prolabium.Additionally, the medial crura of the lower lateral cartilages are splayed with the fibro-fatty tissue of the nasal tipintervening between the tip defining points of the middle crura, resulting in an under projecting nasal tip and shortened columella. Synchronous repair of the nasal deformity at the time of primary cheiloplasty is essential for the treatment of the condition, as cheloplasty and delayed nasal repair result in secondary stigmata including a wide, under projecting nasal tip, short or non-existent columella, and flaring of the nasal ala. The aim of this presentation is to describe the anatomy of the bilateral cleft nasal deformity and to discuss surgical approaches to its correction including the role of presurgical infant orthopedics and strategies for treating asymmetric bilateral clefts.

Methods/Description:
Anatomic studies of nasal anatomy in the setting of the bilateral cleft lip will be reviewed along with a brief overview of the history of staged repair techniques for bilateral clefts. The authors will present an overview of techniques for synchronous bilateral cleft lip and nasal correction with specific attention given to the Mulliken technique of synchronous bilateral cleft lip repair. Outcome studies of various techniques will be discussed as well as the role of presurgical infant orthopedics in treating bilateral clefts and the role of cleft lip adhesion for optimizing outcomes in an asymmetric bilateral cleft lip.

Seminar Objectives:
• Learners will be able to describe the anatomic factors that contribute to the bilateral cleft lip nasal deformity and understand the secondary deformities created by cleft lip correction alone and staged nasal corrections using recruited labial tissue for columellar lengthening.
• Learners will be able to describe common techniques for primary correction of the bilateral cleft lip nasal deformity.
• Learners will understand the importance of preoperative dentofacial orthopedics for optimizing outcomes in bilateral cleft lip correction.
• Learners will be able to describe an approach to correction of asymmetric bilateral cleft lips.