Background and purpose: Today primary repair of cleft lip and palate is not only a lip closure. The repair has become a nasal and lip repair. A good result on the lip is not enough. We must correct the nose in the same operation. A poor result on the nose requires a second surgery functional and/or aesthetics. But the intervention will be more difficult than during the primary time, during which the entire nose is opened, the dissection is easy.
Methods: Technically primary rhinoplasty is possible, it is rather easy, just lengthen the duration of intervention. It may be an isolated septoplasty or rhinoseptoplasty. It helps the dissection of the septum, the alar cartilages, the nasal ala. This septoplasty without resection of cartilage does not cause growth disorders to the nose and it promotes the growth of the maxilla by improving early nasal breathing. It can prevent secondary rhinoplasty, the source of new scars (externally, fork).
Results: Sometimes a secondary deformity after surgery degrades the correct initial result. It may be related to fibrosis, to scar retraction. The degradation of the result imposes the need for a nasal conformer placed postoperatively to maintain the initial result. Sometimes it is a technical problem which causes a deterioration of the result: inadequate dissection, malposition of the septum, alar cartilage, the base of the nasal ala or muscle. Or an excess tissue related to the Millard’s L flap in the plica nasi. In these cases it is not a nasal conformer that will solve the problem. It’s only changing of surgery technique.
Conclusion: Septoplasty and Septorhinoplasty are possible and desirable in the first primary lip closure. But Rhinoplasty will increase the incidence of scar contraction, thus shaping with a nasal conformer is essential.