How to correct the unilateral cleft-lip nose?
1. External rhinoplasty approach
2. Septal correction/reconstruction with medial fixation of the caudal border onto the premaxilla or corrected anterior nasal spine
3. spreadergraft placement to correct loss of middorsal volume on the cleft side adding to symmetry and dorsal septal support
4. dome defining sutures with a LC-steal on the cleft side
5. lateral crural under/overlay to add support and shape of the ala and scroll area
6. tongue in groove to set tipprojection and rotation
7. rimgrafts and capgraft to favor tip contouring, definition and support
8. dorsal contouring with rasping or hump osteotomy
9. osteotomies when indicated (usually only lateral low-low-low and transverse for infraction).
10. inner lining lengthening on cleft side with a v-to-y closure (alternatively composite graft skin-cartilage or buccal mucosa)
11. augmentation of the facial plane underneath the ala on the cleft side using perpendicular plate bone (usually the septal spine)
12. correction of alar inset to symmetrical heights
* Auricular cartilage or rib cartilage might be needed.
** The severity of the unilateral cleft lip nose is very diverse and the final surgical plan needs to be tailored to each individual situation.