Your Questions

Q: Dr. Eppley, my one month old son has cleft lip and palate on the left side. It is due to be repaired in another few months. Besides the cleft lip, the nose is also very distorted and wide set. Can his nose also be corrected at the same time as that of his cleft lip repair?

A: The initial cleft lip repair is usually done around the age of three or four months after birth. During a primary cleft lip repair, efforts are always made to reshape the distorted nostril and tip of the nose. Some of the nose improvements are natural as the lateral lip element is one and the same with the base of the nostril. So the base of the nostril naturally gets better as the two sides of the lips are brought together and united. But one should not think of this nose effort as a definitive rhinoplasyt or a complete correction. The lower alar cartilages of the nose are still deformed and remain small in development. They are far from completely formed and these initial nasal correction efforts at the time of the cleft lip repair are mainly to improve the width of the nostril base. The nose must undergo further development and additional nasal work will be needed during the early school  and teenage years to more extensively reshape the deformed tip cartilages and correct septal deviations and other nasal abnormalities.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have finally decided  as an adult to have my cleft lip scar and nose asymmetry repaired. What I don’t like about my face is that I have a prominent lip scar, a downturned and twisted nose and an overall flatter face. I have attached some pictures so you can clearly see what I mean. What specific procedures do you think I will need and how are they done?

A: Thank you for sending your pictures. You have many of the very typical lip/nose/midface cleft-induced deformities that many so affected patients have. In analyzing how to make a significant improvement, I would recommend the following approach. A full septoprhinoplasty is needed to straighten out the whole nose and give the tip more projection and some narrowing. You would need a cartilage rib graft to build up the base of the nose (pyriform aperture/paranasal regions) by onlay grafting and as a columellar strut to improve tip projection and support. Your cleft lip repair is pretty good at the cupid’s bow area but I would excise the philtral scar and re-unite the underlying orbicularis muscle better.

Dr. Barry Eppley

Indianapolis, Indiana