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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4442_Библиотеки_им_академика_М_И_Перельмана.pdf
Atlas of Primary
Cleft Rhinoplasty
Percy Rossell-Perry
Editor
Atlas of Primary Cleft Rhinoplasty
Percy Rossell-Perry
Editor
Atlas of Primary Cleft
Rhinoplasty
Editor
Percy Rossell-Perry
Union Peruvian University (UpeU)
School of Human Medicine, Lima
Lima, Peru
ISBN 978-3-031-68011-3 ISBN 978-3-031-68012-0 (eBook)
https://doi.org/10.1007/978-3-031-68012-0
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
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dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the
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The publisher, the authors and the editors are safe to assume that the advice and information in this book
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Editorial Contact: Erica deCassiaFerraz
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
To my Lord Jesus Christ who guides all
my works.
To my parents, Blanca and Percy, and my
comprehensive wife, Patti.
To my professors, Drs. Daniel and Claudio
Kirschbaum, who made possible my
professional development in plastic surgery.
I like to express my gratitude to Dr. William
Carter for his generous help as a surgeon
and professor, who provided the best benet
to poor children in Peru.
To the Smile Train Foundation, who
transformed my life making me a man of
service to others.
Finally, this book is dedicated to all my
patients and their parents who have taught
me a lot about love for others.
Foreword 1
In the intricate realm of care for those born with cleft lip and palate, treatment of the
cleft nose stands out for posing both a challenge to surgeon and a benet to patient.
The human face, a canvas of identity and emotion, holds within its delicate structure the power to express an array of sentiments and forge connections. The nose,
front and center in that canvas, is crucial for airow function and dening in appearance. Its trilaminar structure incorporates strength, exibility, symmetry, and threedimensionality. Consequently, rhinoplasty occupies a revered position in plastic
surgery for the technical challenge of achieving excellence. Cleft rhinoplasty
embodies that technical challenge, with added dimensions: a more complex underlying anatomy, evident at birth, for which early treatment can impart early benet,
yet all of which is subject to effects of growth.
There is an urgent need to democratize excellence in cleft rhinoplasty. Cleft lip
and palate are among the most common congenital anomalies, with approximately
200,000 children born with cleft lip/palate in the world each year, most of whom
will have a cleft nasal deformity. The last several decades have seen the proliferation
of multidisciplinary cleft care in specialized centers, achieving great outcomes. We
have also witnessed dramatically improved access to basic cleft lip and palate repair
in lower-resource settings, which is tremendous. Interestingly, however, as patients
age from infancy to adolescence in these regions without ongoing cleft care, differences and ongoing needs emerge with respect to speech, dentition, and nose appearance and function. Patient-reported outcome tools give voice to these young people,
painting a picture in which a persistent cleft nasal difference is highly stigmatizing.
This is not surprising in an era where one’s face—in ubiquitous digital photos, and
looking back from the screen of one’s mobile phone—is ever-present. Thus, there is
a vast and immediate need both to effectively treat the cleft nose of millions of children and young adults and to combine cleft nasal treatment with lip repair in infants.
Fortunately, several factors are shifting the paradigm toward primary cleft rhinoplasty, which is why this book is so timely and important. First, abundant evidence
shows that incorporating nasal surgery with lip repair is safe and does not impair
future growth. Second, outcome studies increasingly illustrate to surgeons (and to
patient families) the improved middle- and long-term outcomes achieved through
primary rhinoplasty. Third, there is increasing recognition of the benets of nonsurgical nasal molding adjuncts that can be used before or after surgery to enhance
the outcomes of primary rhinoplasty and availability of these adjuncts. And fourth,
vii
viii
Foreword 1
increased attention to the specic technical components of cleft rhinoplasty demysties and facilitates familiarity and renement by the surgical community.
Dr. Rossell-Perry is a uniquely qualied guide on this journey. His three-decade
career, which includes both leading a large urban cleft team in Lima and regular
outreach activities in rural areas of Peru, imparts deep clinical experience.
Furthermore, he is a gifted clinical scientist who has both carefully studied and
reported patterns of his own surgical outcomes and is well-acquainted with contemporary evidence-based care. Throughout the pages of this comprehensive guide,
readers will explore the anatomical complexities and surgical techniques that dene
primary cleft rhinoplasty. Each chapter meticulously blends theoretical knowledge,
practical insights, and visual guidance, empowering both novice and experienced
surgeons to rene their skills and achieve optimal outcomes.
In a eld where precision is paramount, this atlas does more than present surgical
techniques; through clinical examples, it encapsulates the profound impact of primary cleft rhinoplasty on patients’ lives. By restoring the physical harmony of the
nose and lip, as well as the condence and self-esteem of those affected, this procedure embodies the essence of reconstructive surgery. As you delve into the chapters
that follow, may you nd inspiration in the artistry of primary cleft rhinoplasty. May
this atlas serve as a beacon of knowledge, guiding you toward the highest standards
of patient care and surgical excellence. Together, let us continue to push the boundaries of what is possible, transforming challenges into triumphs and bringing smiles
to those who need them most.
Division of Plastic, Reconstructive and Oral Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
July 2024
JordanW.Swanson
Foreword 1
Fig. 1 Dr. Percy
Rossell-Perry with
Dr.Jordan Swanson during
Brazilian Cleft Palate
Craniofacial meeting in
Campinas, São Paulo, 2024
ix
Foreword 2
The cleft lip and palate eld has been close to my heart for the past 35 years. It has
been my good fortune to have been trained and later to work together with outstanding and passionate surgeons for congenital defects.
The biological revolution of the past century has seeded a owering biotechnology
revolution in the twenty-rst century. The main goal for people interested in craniofacial dysmorphogenesis has always been to create lasting treatment concepts based on
a better understanding of the natural history of cleft lip and palate and facial growth.
Most of the time, new book readers look for knowledge acquisition, for references to previous books, for the author’s personal thoughts, for treatment protocols,
and, above all, for rapid synopsis via readable images. Indeed, these ingredients are
all present in the Atlas of Primary Cleft Rhinoplasty and are well framed by repeated
landmarks in a concise and descriptive text.
A single-author book is more pleasant to read chapter after chapter than one with
many co-authors from whom personal thoughts, methods, planning, and results do not
emerge. Therefore, an individual’s remarkable progress toward analysis and understanding fosters approaches that can produce good functional and aesthetic results.
In the wide spectrum of cleft lip and palate disorders, the function (speech,
breathing, swallowing) predominates over form. But whatever the function involves,
form is always present and the obsession with form will persist.
In the past decades, surgery has been able to transform malformed faces into normal ones, but newer investigations, techniques, and tools have repeatedly improved
results and the speed with which they are accomplished. Very illustrative examples of
surgical technique evolution are widely represented in the pages of this excellent atlas.
Cleft lip and palate surgery can usually correct disordered faces with applications
of experience and great surgical skill, both of which are apparent in these chapters.
Last but not least, one can not mention enough the fundamental life changes
experienced by countless children whose lip and palate abnormalities have been
treated in recent decades, and also it is important to mention the support and understanding of parents and family.
Miami, FL, USA August 2024
xi
xii
Foreword 2
Fig. 2 Dr. Molina and Dr. Rossell-Perry during the Latin American Craniofacial Association
meeting in São Paulo, Brazil, 2018