History of the Primary Cleft Rhinoplasty

For a long time, there was a concern regarding the impact of primary nasal repair in patients with cleft lip and palate. Surgeons considered the potential effect on the growth of the nose and other undesirable side effects, and their recommendation was to delay the surgery until adulthood. In 1955, Gustav Aufricht mentioned: “Please do not touch the nasal tip until the child is at least a teenager.” This is the reason why initial cleft rhinoplasty techniques were described for secondary nose deformities. The psychological impact of the sequels on patients with cleft lip and palate during their childhood and adolescence has been better considered, and many surgical methods have been proposed in order to improve the quality of life of these patients. Primary nasal repair has become important for cleft surgeons and is currently considered a standard of care for any cleft protocol based on recent scientific evidence. Blair and Brown first described a cleft rhinoplasty technique in 1931 and later Harold McComb’s contributions regarding the abnormal gross anatomy and better understanding of the cleft nose deformity; different techniques have been published, but there is no consensus at present. During the early 1990s, the use of an innovative technology named as Naso Alveolar Molding (NAM) was introduced by Grayson and has been used to improve congenital anatomy and facilitate the primary nasal repair; however, there is a lack of scientific support for its long-term efficacy. This chapter presents a review of the history of cleft lip nasal repair to the reader.