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10 Cleft Rhinoplasty-Related Complications andManagement
337
Finally, for more detailed description of bad outcome treatment, the reader may
revise the author’s textbook: Atlas of Non-desirable Outcomes in Cleft Lip and
Palate [51].
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41. Rossell-Perry P.New diagram for cleft lip and palate description: the clock diagram. Cleft
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45. Rossell-Perry P.The vestibular marginal excision technique for secondary correction of nasal
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P. Rossell-Perry
10 Cleft Rhinoplasty-Related Complications andManagement
47. Farkas LG, Hajnis K, Posnick JC.Anthropometric and anthroposcopic ndings of the nasal
and facial region in cleft patients before and after primary lip and palate repair. Cleft Palate
Craniofac J. 1993;30(1):1–12.
48. Rossell-Perry P.Rotational composite ap technique for primary incomplete cleft nose deformity. Plast Reconstr Surg Glob Open. 2020;8(6):e2870.
49. Yeow V, Chen P, Chen Y, Noordhoof S.The use of nasal splints in the primary management of
unilateral cleft nasal deformity. Plast Reconstr Surg J. 1999;103(5):1347–54.
50. Mendez R, Lopez-Cedrun J, Tellado M, Somoza I, etal. Nostril retainers in the primary cleft
rhinoplasty. Cir Pediatr. 2005;18(4):200–3.
51. Rossell-Perry P.Atlas of non-desirable outcomes in cleft lip and palate. Cham: Springer; 2022.
339
Index
A
Acrylic device, 286
Acrylic nasal conformer, 336
Aesthetic nasal subunits of the nose, 10
Ala, 9
Alar base, 9, 139, 142, 212
Alar cartilage, 139, 143, 210, 213, 215, 250
Alar crease, 9
Alar facial sulcus, 9
Alar groove, 9
Alar lobule, 9, 10
Alar nose shortening, 315–318, 329
Alar shift operation, 47, 50
Alar sulcus, 9
Allergy, 279
Alveolar bone graft later during mixed
dentition period, 253
Alveolar component, 117–119
Alveolar molding using plates, 100, 101
Amoxicillin, 297
Analgesics, 271
Antibiotics, 271
Aspiration of the impression material, 293
Aufricht, Gustav, 43, 44
Auricular cartilage graft, 303
Auricular composite graft technique, 318
B
Banked fork ap technique, 55, 56
Berkeley´s method, 146, 220
Berkeley’s concept, 325
Bilateral cleft lip, 40
Bilateral cleft lip and palate, 96, 97
Bilateral cleft lip combined forms, 82, 216
Bilateral cleft lip labial nasal muscles, 34
Bilateral cleft lip nasal deformity, 41, 55, 57
Bilateral cleft lip nasal repair, 218
Bilateral cleft lip nose deformity, 207, 208,
210, 211, 216
bilateral cleft lip combined forms, 216
complete, 213–216
incomplete, 211, 213
mild, 208
moderate, 208
severe, 209
surgical protocol, 217, 218
Bilateral cleft lip nose repair, 219, 220, 291
complete bilateral cleft lip nose
surgical treatment for, 261, 262
VYZ technique in, 244–247, 249–253,
255, 256, 258, 261
composite rotational ap rhinoplasty, 229,
233, 236, 237, 239
presurgical considerations
anesthesia, 222–224
evaluation, 221
instruments, 221
Mc Comb technique, 225
Bilateral cleft lip patient, 14
Bilateral cleft nasal deformity, 45
Bilateral cleft rhinoplasty, 45, 55
Bilateral combined cleft lip nose defor-
mity, 82, 83
Bilateral complete cleft lip, 78, 79
Bilateral complete cleft lip nose defor-
mity, 79, 80
Bilateral external nasal nerve block, 224
Bilateral incomplete cleft lip nose, 80
Bilateral incomplete cleft lip nose
deformity, 81
Bilateral infraorbital nerve block, 223, 224
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2024
P. Rossell-Perry (ed.), Atlas of Primary Cleft Rhinoplasty,
https://doi.org/10.1007/978-3-031-68012-0
341
342
Index
Bilateral primary cleft rhinoplasty
poor outcomes associated with, 324–326,
328, 329, 331, 333–336
Bilateral single-stage cheilorhinoplasty, 58
Bipedicled composite aps, 45
Blair and Brown’s cleft rhinoplasty, 47
Blair, Vilray, 46
Bony-cartilaginous framework, 18, 19
Brown, 46
C
C ap, 47
CAD phase, 118
CAD/CAM technology, 114
CAM phase, 118
Cartilaginous framework, 11–16
Cartilaginous framework of the nose
diagram, 11
Cartilaginous grafts, 309
Cartilaginous middle vault area, 4
Caudal septoplasty, 186
Caudal septum, 5, 16, 154
Caudal septum dissection, 225
Caudal septum inltration, 151
Central segment and nasal vestibule inltra-
tion, 222, 223
Cheiloplasty, 175, 193, 239
Children stress, 293
Classication of severity, 69
Cleft code, 91
Cleft lip, 91
Cleft lip and palate (CLP), 22, 45, 96
Cleft lip nasal deformity, 47
Cleft lip nose, 39–41
Cleft lip repair, 22, 204
Cleft nose deformity, 45, 63
Cleft rhinoplasty, 91, 92, 173, 290
complications
dimples, 301
foreign body, 298
granulomas, 298
hypertrophic scarring, 294, 296, 297
lateral web, 301, 303, 304
notching, 301
postoperative bleeding, 294
postoperative wound infection,
297, 298
with pre and postsurgical orthope-
dics, 293
skin necrosis, 300
suture allergic reaction, 301
poor outcomes associated with bilateral
primary cleft rhinoplasty, 324–326,
328, 329, 331, 333–336
poor outcomes associated with unilateral
primary cleft rhinoplasty, 305–309,
311, 313, 315, 318, 319, 321–323
quality of surgical outcomes, 290, 292
Cleft rhinoplasty technique, 45
Clock diagram, 68, 69, 71, 84, 90
Columella, 9, 10, 138, 143, 212, 215
Columellar artery, 25
Columellar lateral Z plasty, 252, 253
Columellar lengthening, 57
Complete bilateral cleft lip and palate, 60,
121, 122, 284
Complete unilateral cleft lip and palate, 120,
123, 286
Complete unilateral cleft lip nose deformity,
140, 142, 143
Composite rotational ap rhinoplasty, 162
bilateral cleft lip nose repair, 229, 233
nasal oor, 239
nasal septum, 236
nasal tip dissection, 233
nasal tip reconstruction, 236, 237, 239
marking, 162, 164
nasal oor, 173, 175
nasal septum, 167
nasal tip reconstruction, 167, 172
rotational composite ap and nasal tip
dissection, 166
Compressor naris muscle, 32
Compressor nariswrinkles, 32
Computer aided-manufacturing (CAM), 112
Computer-aided design (CAD), 112
Congenital anomalies in cleft noses, 3
Congenital auricular deformities, 96
Cosmetic rhinoplasty, 301
Cribriform plate, 21
Cronin´s bilateral cleft rhinoplasty, 57
Cronin, Thomas, 56
D
Denitive rhinoplasty
surgical timing, 93
Degrees of severity, 68
Depressor septi nasalis muscle, 32
Dicloxacillin, 297
Dimples, 301
Dorsal nasal artery, 25
Dynacleft, 98, 111
Index
343
Dynacleft method, 275
Dynacleft nasal elevators, 62
Dynacleft system, 274
E
Elastic bandages, 100
Elvis Presley muscle, 32
Ethmoid arteries, 25
Ethmoid bone, 21
External arteries of the nose, 26
External nasal artery, 25
External nasal nerve block, 149, 222
External nasal nerve block procedure, 150
External nasal valve, 35, 36
External nose, 3, 4
External nose anatomy, 4
F
Feeding, 272
Foreign body complications, 298
Forked ap method, 45, 55
G
Gillies, Harold, 207
Gillies, Sir Harold Delf, 48
Gingivoperiosteoplasty (GPP), 97, 142
Gothenburg protocol, 22
Granulomas, 298–300
Grayson, Barry, 61
H
Hard tissue complications, 126
Hypertrophic scar formation, 272
Hypertrophic scar prevention, 272
Hypertrophic scarring, 294, 296, 297
I
Incomplete bilateral cleft lip, 283
Incomplete unilateral cleft lip, 285
Incomplete unilateral cleft lip nose deformity,
137, 138, 140
Infections, 126, 293
Infraorbital nerve block, 149, 222
Infraorbital nerve block internal approach, 150
Intercartilaginous border, 182
Intercartilaginous incision, 165
Intercartilaginous line, 164
Interdisciplinary cleft care, 267
Intermediate cleft rhinoplasty
surgical timing, 92
Internal lateral wall, 20, 21
Internal nasal nerves, 31
Internal nasal valve, 7, 36, 38, 39
Internal nose, 4–6, 8
Internal nose anatomy, 5
J
Joseph, Jacques, 44
K
Kernahan and Stark’s classication, 68
Kilner, Thomas Pomfret, 49
L
Labial component, 113
Lateral crura, 11
Lateral nasal artery, 25
Lateral segment inltration, 224
Lateral web, 301, 303, 304
Lateral Z plasty, 52, 146, 181, 183, 186, 188,
189, 220, 246, 248, 250, 308, 325
Lateral Z plasty dissection, 186
Levator labii superioris alaeque nasalis
muscle, 32
Levator labii superioris alaeque nasi and
orbicularis oris muscles, 191
Levator labii superioris alaeque nasi muscle,
175, 191
Lima outreach surgical center classication of
severity, 84, 85, 87, 91
Lima protocol for cleft palate repair, 23
Limen nasi, 16
Lip taping, 60, 98–100, 113
Lower lateral cartilage, 12
Lower lateral cartilage displacement, 14
M
Manchester technique, 328
Maxilla, 140, 143, 213
Maxillary arch molding, 194
Maxillary hypoplasia, 39, 132
Maxillary processes, 1
Mc Comb cleft rhinoplasty, 226
Mc Comb method, 54, 220
Mc Comb modied cleft rhinoplasty, 155
344
Index
Mc Comb modied technique, 157, 162, 181,
186, 226, 227, 229, 307
bilateral cleft lip nose repair, 225
unilateral cleft lip nose repair, 151
caudal septum dissection, 152
nasal oor repair, 152
nasal structures reposition, 152
nasal tip dissection, 152
McComb, Harold Keith, 53
Microform unilateral cleft lip nose defor-
mity, 136
Mild nose component bilateral cleft lip nose
deformity, 86
Mild nose component unilateral cleft lip nose
deformity, 84
Mild primary palate component bilateral cleft
lip nose deformity, 89
Mild primary palate component unilateral cleft
lip nose deformity, 87
Millard, 51
Mink´s nasal valve, 37, 38
Moderate nose component bilateral cleft lip
nose deformity, 86
Moderate nose component unilateral cleft lip
nose deformity, 85
Moderate primary palate component bilateral
cleft lip nose deformity, 89
MRSA (methicillin-resistant Staphylococcus
aureus), 297
Mulliken’s technique, 38, 220
Muscular hypoplasia, 253
Muscular repair, 214
Musculo aponeurotic system, 30–32
Myrtiformis muscle, 32
N
Narrower nasal sill, 319, 321, 334
Nasal aesthetic subunits, 9, 10
Nasal airway, 38
Nasal ala, 313, 314, 328
Nasal ala asymmetry, 328, 329
Nasal ala in the lower position, 313, 315
Nasal ala in the upper position, 315
Nasal bleeding, 293
Nasal bridge, 8
Nasal cartilages, 15
Nasal columella, 14–16
Nasal components, 12, 13, 20, 24
internal lateral wall, 20, 21
nasal columella, 14–16
nasal oor, 21, 24
nasal septum, 18, 19
nasal tip, 11–13
nasal vestibule, 16–18
Nasal dorsum, 10
Nasal external skin, 28
Nasal oor, 21, 22, 24, 138, 142, 173, 175,
191–193, 211, 213, 239, 253
Nasal oor repair, 225
Nasal lobule, 9
Nasal mucosa, 4
Nasal muscles, 33
Nasal packing, 294
Nasal packing technique, 270
Nasal physiology, 35, 36, 38, 39
Nasal septum, 5, 6, 18, 19, 29, 131, 139, 143,
167, 186, 213, 215, 236, 250
Nasal sill, 9, 319, 331–333
Nasal structures reposition, 225
Nasal systems
musculo aponeurotic system, 30–32
nervous system, 28–30
vascular system, 24, 25, 28
Nasal tip, 4, 9, 11–13, 139, 143, 190, 213,
215, 308, 309, 311, 325, 326
Nasal tip asymmetry, 308, 309, 312
Nasal tip dissection, 225
Nasal tip inltration, 151
Nasal tip notching, 302, 303
Nasal tip reconstruction, 167, 172, 189, 236,
237, 239, 250
Nasal valve area of the nose, 4
Nasal vestibule, 16–18, 35, 39, 322,
323, 334–336
Nasal vestibule scar, 322
Nasal vestibule scar contracture, 334
Nasalis muscle, 32
Naso alveolar molding (NAM), 45, 61, 62,
109–112, 215, 220, 292, 293, 324
Naso alveolar clefts, 96
Naso alveolar molding (NAM) protocol,
96, 97, 146
Nasolabial angle, 9
Nervous system, 28–30
Nose, 1
external, 3, 4
internal, 4–6, 8
surgical anatomy
musculo aponeurotic system, 30–32
nasal aesthetic subunits, 9, 10
nasal components, 11–21, 24
nasal surface anatomy, 8, 9
nasal systems, 24
Index
345
nervous system, 28–30
vascular system, 24, 25, 28
Nose deformity repair, 45
Nostril, 9, 140, 143, 213
Nostril sill, 142
Nostril stenosis, 282
Notching, 301
NSAID, 151, 224
O
Olfactory region, 35
Open rhinoplasty, 57
Orthonostric appliance, 279, 280
Orthonostric approach, 279
Oslo protocol, 23, 142
Overcorrection techniques, 38
Overlaying soft tissues, 13, 16
Overlying mucosa, 19
P
Passive nasoalveolar molding, 279
Passive orthopedic plates, 101
Philtral ap, 253
Porex R stents, 274, 279
PorexR silicone stent, 283
Post-anesthesia care unit monitoring, 268
Postoperative nasal conformers, 274, 277, 336
types, 277
acrylic custom-made nasal stent, 277
orthonostric appliance, 279, 280
three-dimensional printer rhinoplasty
appliance system (RAS), 278, 279
Postoperative nerve block, 151
Potter´s concept, 47, 146, 220, 325
Premaxilla, 19, 215
Pressure sores, 293
Presurgical infant orthopedics (PSIO), 120
Presurgical management, 96
Presurgical orthopedic method, 96
benet, 97
labial component, 113
naso alveolar molding (NAM), 109–111
non-surgical orthopedics
alveolar molding using plates, 100, 101
elastic bandages, 100
lip taping, 98–100
poor outcomes and complica-
tions, 125–127
rhinoplastic appliance system, 114–116
surgical orthopedics, 102, 103
marking, 103
3D CAD-CAM, 112
Presurgical orthopedics, 45, 60–62
Primary bilateral cleft rhinoplasty, 103,
216, 220
Primary cheiloplasty, 328
Primary cheilorhinoplasty, 91, 313, 328
Primary cleft cheilorhinoplasty, 193
Primary cleft lip repair, 98
Primary cleft rhinoplasty, 48, 55, 62, 92, 98,
143, 146, 147, 149, 191, 221, 268
history of, 43, 45
advances in, 64
bilateral cleft lip nasal defor-
mity, 55, 57
presurgical orthopedics, 60–62
unilateral cleft lip nasal deformity,
45, 47–49
postoperative management
agitation control, 271
feeding, 269
pain management, 271
post-anesthesia care unit moni-
toring, 268
postoperative nasal conformers,
274, 277
short-term postoperative care, 271, 272
wound care, 268, 269
postoperative nasal conformers, 62, 63
surgical timing, 92
Primary lip cheilorhinoplasty, 146, 221
Primary palate, 21, 85
Primary palate (alveolus), 142
Primary septoplasty, 49
Procerus muscle, 32
Prolabium ap, 103
Q
Quadrangular cartilage, 18
Quality of life, 45
R
Respiratory region, 35
Rhinoplastic appliance system (RAS),
114–116, 120–123, 274, 276–278
Root, 8
Rotation composite ap method, 220
Rotational composite ap cleft rhinoplasty,
163, 164, 173, 230, 233
Rotational composite ap technique, 166, 309
346
Index
S
Salyer´s methods, 152
Scar care, 272
Scar contracture, 295, 323
Secondary cleft rhinoplasty, 48–49
Secondary columellar deciencies, 318, 329
Secondary deformities, 45
Secondary nasal deformity, 305
Secondary palate, 21, 87
Secondary palate (hard palate), 142
Secondary palate (soft palate), 142
Semilunar incision, 53
Sentinel events, 290
Septal cartilage, 18
Septoplasty, 152
Severe nose component bilateral cleft lip nose
deformity, 87
Severe nose component unilateral cleft lip
nose deformity, 85
Severe primary palate component bilateral
cleft lip nose deformity, 90
Severe primary palate component unilateral
cleft lip nose deformity, 88
Short columella, 40, 329–331
Silicone PorexR stents, 284
Simonart’s band, 134, 214
Single-stage nasolabial repair, 57
Skeletal deformity, 207
Skeletal hypoplasia, 74
Skin irritation, 293
Skin necrosis, 300
Soft palate, 22
Soft triangle, 9, 10
Soft triangle of the nose, 37
Sphenopalatine, 27
Supercial musculo aponeurotic system
(SMAS), 30–32
Supracartilaginous plane, 167
Supratip area of the nose, 13
Surgical nasoalveolar molding, 101, 133, 143,
146, 181, 191, 193, 211
Surgical timing, 91, 92
intermediate cleft rhinoplasty, 92, 93
primary cleft rhinoplasty, 92
Suture abscess, 297, 299
Suture allergic reaction, 301
Suture hypersensitivity, 301
Syndromic cleft lip and palate, 147
Synechia, 296, 297, 334, 336
Synechiae, 300, 322
T
Tajima cleft rhinoplasty, 60
Temporary stent transcutaneous sutures, 48
3D CAD-CAM presurgical orthopedics, 112
Three-dimensional printer rhinoplasty
appliance system (RAS), 278, 279
Tip lobule, 10
Transcutaneous stitch technique sequence, 170
Transpositional aps, 186, 250
Trigeminal nerve, 29
Turbinate, 20
Turbinate hypertrophy, 132
U
Ulceration, 126
Unilateral cleft lip, 39, 45, 202
Unilateral cleft lip and palate, 23, 72
Unilateral cleft lip labial nasal muscles, 34
Unilateral cleft lip nasal deformity, 40,
45, 47–49
alar base deformity, 135
complete, 140
incomplete, 138, 139
microform, 136
mild, 132
moderate, 132
nasal tip and columellar deformity, 133
severe, 133
Unilateral cleft lip nasal repair surgical
protocol, 144
Unilateral cleft lip nose deformity, 131–134
complete, 140, 142, 143
incomplete, 137, 140
microform, 136
surgical protocol, 143
Unilateral cleft lip nose repair, 146, 291
anesthesia., 149, 151
composite rotational ap rhinoplasty, 162
marking., 162, 164
nasal septum., 167
nasal tip reconstruction., 167, 172,
173, 175
rotational composite ap and nasal tip
dissection., 166
Mc Comb modied technique, 151
caudal septum dissection., 152
nasal oor repair., 152
nasal structures reposition., 152
nasal tip dissection., 152
Index
347
presurgical considerations, 146
instruments., 147, 148
preoperative evaluation, 147
surgical technique., 181–183, 186,
189, 191–193
V-Y-Z cleft rhinoplasty, 181
Unilateral complete cleft lip nose, 74
Unilateral complete cleft lip nose defor-
mity, 74, 75
Unilateral incomplete cleft lip nose, 76
Unilateral incomplete cleft lip nose defor-
mity, 76, 77
Unilateral microform cleft lip nose, 77
Unilateral microform cleft lip nose defor-
mity, 77, 78
Unilateral primary cleft cheilorhinoplasty, 271
Unilateral primary cleft rhinoplasty, 275
poor outcomes associated with, 305–309,
311, 313, 315, 318, 319, 321–323
Unilateral rotational composite ap cleft
rhinoplasty, 168
Upper lip, 84
Upper lip and nose embryology, 2
V
V advancement ap, 249
V composite ap, 184
V composite ap and nasal tip dissection, 183
Vascular system, 24, 25, 28
Veau, Victor, 68
Veau’s classication, 67
Veau’s classication for cleft palate, 69
Vestibular inltration, 151
Vestibular nasal oor reconstruction, 157
Vestibular scar contracture, 295
Vestibule of the nose, 17
Vomer, 19
Vomeropremaxillary junction synostosis,
97, 126–127
V-Y advancement, 146, 189, 304
V-Y advancement ap cleft
rhinoplasty, 50
V-Y ap, 181
V-Y-Z cleft rhinoplasty, 167, 181, 191
VYZ primary cleft rhinoplasty, 304
VYZ rhinoplasty, 311
V-Y-Z surgical technique, 296, 335
VYZ technique, 190, 194, 198, 200, 204, 297
VYZ technique in complete bilateral cleft lip
nose, 244–247, 249–253, 255, 256,
258, 261
W
Wide columella, 331, 332
Wider nasal oor, 319, 320
Wings of the nostrils, 9
Wound care, 268, 269, 272
Wound healing, 277
Wound infection, 298
Y
Y form method, 68
Y-shaped cleft lip, 70
Z
Z plasty, 47, 52, 303