The cleft nose is one of the most challenging pathologies for rhinologists and facial plastic surgeons to address. The combination of architectural deformity (related to the extent of lip deformity) and scarring from previous surgery combine to cause the surgical difficulties. This is a well-written and well-illustrated article that goes over the anatomical problems in the unilateral and bilateral cleft nose. The article covers both primary rhinoplasty but the emphasis is on the definitive secondary rhinoplasty. Treating the nasal vault and tip is often performed with septal extension grafting using rib cartilage as this has rigidity, carveability, volume and resistance to post-operative contracture. An often overlooked area is the piriform rim and pre-maxilla and the authors cover management of this complex area particularly well. The authors argue that simultaneous grafting with an implant or cartilage while treating the nasal tip results in the best functional and aesthetic outcomes as well as patient satisfaction. This a very thorough article which provides a good insight into management of the cleft nose. 

Rhinoplasty for the cleft lip and palate patient.
Cuzalina A, Jung C.
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Deepak Chandrasekharan

UCL, London, UK.

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