Primary rhinoplasty in a patient with a history of cleft lip and palate: Case report

Abstract

Introduction: Cleft lip and palate (CLP) is one of the most common craniofacial malformations, with an approximate incidence of 1 in 700 live births. Despite early surgical correction through cheiloplasty and palatoplasty, secondary nasal deformity represents one of the most complex aesthetic and functional challenges in plastic and reconstructive surgery. This deformity is typically characterized by septal deviation, ipsilateral nasal ala collapse, and alar base hypoplasia, which compromise both respiratory function and the patient's facial appearance. The surgical approach to these sequelae requires individualized planning that integrates functional and aesthetic techniques simultaneously.

Clinical Case: A 21-year-old male patient with a history of unilateral cleft lip and palate, corrected by cheiloplasty and palatoplasty at 5 months of age. The patient presented for evaluation of residual nasal deformity, including septal deviation with nasal obstruction, ipsilateral nasal ala collapse, and alar base hypoplasia, with significant functional and aesthetic repercussions. A combined functional and aesthetic rhinoplasty was planned and performed under general anesthesia. The procedure included septoplasty to correct the deviation and improve airflow, auricular cartilage grafting for support and projection of the collapsed nasal ala, and osteotomies to refine the bony nasal pyramid. The surgical time and intraoperative course were uneventful.

Discussion: Nasal deformity secondary to cleft lip and palate (CLP) is a complex condition that is not completely resolved by primary surgeries in infants. The ipsilateral alar cartilage is often hypoplastic, displaced, and asymmetric, leading to both nasal obstruction and persistent facial asymmetry. In this case, the combined approach allowed for simultaneous treatment of the respiratory dysfunction and aesthetic sequelae, avoiding the need for multiple interventions. The use of autologous cartilage grafts from the auricular concha offers advantages such as biocompatibility, low risk of resorption, and technical availability, making it a widely supported option in the literature for managing these deformities. Osteotomies complemented the outcome by improving the symmetry of the nasal bone base. Septoplasty, in addition to its functional benefit, contributed to the correction of the nasal axis.

Conclusion: Combined functional and aesthetic rhinoplasty represents an effective strategy for the comprehensive management of secondary nasal deformities in patients with a history of cleft lip and palate. In this case, the one-month postoperative course was satisfactory, without complications, and with objective improvement in nasal patency and facial symmetry. This report highlights the importance of an individualized and multidisciplinary surgical approach in the long-term follow-up of these patients.