Repair of the bilateral cleft lip deformity.

The bilateral cleft lip is a complex deformity involving discontinuity of the soft tissue layers of the lip and, frequently, the underlying bony structure. Satisfactory repair requires a thorough understanding of the anatomic deformity. The authors' philosophy and timing of the bilateral cleft lip repair are discussed. Details of the surgical technique are outlined.

Correction of the cleft-lip nasal deformity.

Correction of the cleft-lip nasal deformity is a difficult task that requires a clear understanding of the associated complex anatomic abnormalities. These deformities tend to accentuate as nasal growth continues. Primary tip rhinoplasty in the unilateral deformity improves nasal tip symmetry and decreases the need for intermediate surgery. Intermediate rhinoplasty in the bilateral deformity is performed when nasal tip projection is markedly diminished. In both the unilateral and bilateral deformity, definitive rhinoplasty utilizing the open-structure rhinoplasty approach allows maximum exposure for placement of structural grafts to improve tip projection, definition, support, and function. In this article, the pathologic anatomy of the unilateral and bilateral cleft nasal deformity is described. The philosophy and timing of repair are discussed. Finally, the techniques used by the authors to address both the aesthetic and functional problems are outlined.