Introduction

Cleft palate rhinoplasty is one of the most challenging areas of rhinoplasty. When you are deciding on who should perform your cleft palate rhinoplasty Dr Robinson urges you to verify how many rhinoplasties that surgeon performs each year and ensure they are performing more than 100 rhinoplasties per year. Cleft palate rhinoplasty is unforgiving to the uninitiated and is not an operation that should be done by the occasional rhinoplasty surgeon. Dr Dan Robinson has performed more than 1,500 rhinoplasties and does more rhinoplasties per year than anyone else in Queensland.

Regardless of who you decide to pick as your surgeon – Dr Robinson feels that if you are having a cleft palate rhinoplasty – you should go to a surgeon who regularly performs rhinoplasties. This operation is not for first-time surgeons, and if done badly sometimes cannot be undone.

Make sure the surgeon who is doing your cleft palate rhinoplasty performs a minimum of 100 rhinoplasties per year. Preferably they should also have done a fellowship in facial plastic surgery. While these may seem like rude questions to ask the surgeon, it is important that someone with an extremely high level of experience performs your cleft palate rhinoplasty.

Other rhinoplasties that specifically require a lot of previous experience include – but are not limited to – are:

• Binders syndrome.
• Hemifacial microsomia.
• Oblique facial cleft.

If you have these conditions Dr Robinson strongly feels that you should be having an operation with a surgeon who performs more than 200 rhinoplasties per year. If you are seeking a recommendation of someone other than Dr Robinson to perform these procedures get in touch with his rooms and he can assist you. There are very few surgeons in Australia who have the required experience and caseload to tackle the challenges these cases can bring.

The challenges of cleft palate rhinoplasty are many, whether it be unilateral or bilateral cleft. Treatment of a cleft palate rhinoplasty needs to encompass both the functional aspects of the cleft nose as well as the cosmetic components at the same time. Many general plastic surgeons do not feel comfortable performing the functional components of cleft palate rhinoplasty which then necessitates another operation. Dr Dan Robinson addresses both aspects of the operation at the same time – removing the requirement for a second procedure.

The challenges of cleft palate rhinoplasty are different between a unilateral cleft and a bilateral cleft.

Procedure

Unilateral cleft rhinoplasty

The issues with a unilateral cleft rhinoplasty include:

• Caudal dislocation of the septum to the non-cleft side.
• Immediate deviation of the septum to the cleft side.
• Lack of vestibular skin on the cleft side.
• Hooding of the rim.
• Potential septal perforation.
• Short medial crus and long lateral crus of lower lateral cartilage on the cleft side.
• Potential under projection.

Failure to address all these issues will result in a poor outcome. Dr Robinson always uses rib grafting in cleft rhinoplasty and has a low threshold to also use conchal cartilage grafting for the vestibular lining. Dr Robinson also tries to not perform cleft rhinoplasty until a patient is at least 17 years of age.

Dr Robinson has also performed several revisions on patients with a unilateral cleft. The complexity of the operation in this circumstance is extremely high and can include a substantial amount of scarring which needs to be addressed.

Bilateral cleft rhinoplasty

The issues with a bilateral cleft rhinoplasty include:

• Lack of projection.
• Lack of tip support.
• Potential septal perforation.
• Potential retracted alar.

To fix all these issues patients always require rib grafting, and potentially stretching of the skin of their nose to break down subdermal scar.

Gallery

You can view before and after patient photos in the Cleft Palate Rhinoplasty Gallery.

Related Information

Cleft Palate

To discuss if cleft palate rhinoplasty is recommended for you, please make an appointment with Dr Dan Robinson.