Surgical Techniques for Bilateral Cleft Lip Nose Repair

Bilateral cleft lip and nose repair is challenging and requires surgeon’s experience and skills. The skeletal deformity characterized by premaxillary protrusion creates a difficult scenario for primary lip and nose reconstruction and explain the high rate of secondary procedures; this is the reason why these patients may require presurgical improvement of the skeleton before any primary repair, involving the interdisciplinary cleft team for this purpose. Utility of the presurgical nasal molding for primary nose repair purpose is under debate actually due to the lack of scientific evidence supporting its efficacy. Temporary effect has been reported in the literature, and its use is only recommended in combination with primary rhinoplasty. Author’s philosophy for bilateral cleft lip nose repair is characterized by an individualized treatment of the cleft deformity, so the rotational composite flap and the V-Y-Z techniques are used actually by the author to address the nose deformity in bilateral cleft lips. These methods have been studied and published observing good quality of outcomes, and they are described in detail and included well-illustrated cases in this chapter.