External septorhinoplasty in the cleft lip nose.

When the entire septum as well as the cartilaginous vault are exposed to direct vision by degloving the nasal covering, the complete extent of the deformities in cleft lip nose can be clarified. The septal cartilage is hollowed out leaving an L-shaped anterosuperior portion, whereas the intranasal structures are simultaneously altered to ensure the patency of the nasal airway. An adequate-sized piece is cut from the removed cartilage and is fitted to the anterior part of the remaining cartilage to enforce the columella, which acts as a strut to keep both lower lateral cartilages symmetrical and to create a nasal tip. Thus, a new cartilaginous pyramid with symmetrical nostrils is reconstructed. If the anterosuperior portion of the cartilage is deviated, the concave surface is scored to allow it to be straightened before the strut is fitted. Satisfactory cosmetic and functional results were obtained in most patients with adult cleft lip nose, including those associated with deviation, without any major complications.