Nasal deformities in children may be secondary to trauma or birth defects, the most common of which is cleft lip and cleft palate. Other less common birth abnormalities include Binder’s syndrome, nasal bifidity, and nasal duplication. While discovering that your child has cleft lip or another nasal deformity may be discouraging, it’s important to remember that treatment options are available.
If you’re ready to take the next step, request a consultation online or call us at (469) 375-3838 for more information about nasal deformities.
Surgical Considerations
Since the nose does not attain adult dimensions until mid to late adolescence, surgical treatment must be carefully weighed to make sure that permanent bridges are not being burned. Things that we avoid in the early treatment are the transfer of skin replacement flaps which fail to reach adult dimensions and thereby permanently limit the expected outcome. A good example of this is the use of forehead flap tissue which makes a near perfect replacement of nasal skin but which should ideally be used only one time to minimize forehead donor scarring. Rib grafts to replace underdeveloped or injured skeleton may be used on repeat occasions to keep up with growth as long as the donor source on the chest is not exhausted.
Nasal Airway
The nasal airway in children deserves special consideration as the adjoining sinus cavities are only partially developed. In our series of cleft lip and palate patients, less than 3% required work on the septum before their definitive rhinoplasty in adolescence. Though the airway is more restricted on the cleft side, the septum is seldom the sole cause of sinus blockage and infection. Almost all of our children requiring septoplasty have had concomitant allergies as a part of their disease. When airway work is required, we make a special effort to preserve septal cartilage. This is important since the septal cartilage is used as a very essential part of the definitive tip reconstruction in adolescence.
Complete or partial blockage of the airway may occur in infancy. Choanal atresia (complete blockage) may involve one or both sides. Bilateral choanal atresia is an airway emergency and is diagnosed soon after birth. Surgery to open the passages and nasal stinting to maintain the airway is required. Unilateral choanal atresia is more subtle and may simply present as a continuous “runny nose” on one side. Surgical treatment is required.
Surgical Treatment
We routinely treat the nasal deformity of cleft lip and palate in infancy at the time of lip repair. Having followed these children to adulthood and performed over 1500 cases, we are certain that there is no interference of growth with this repair (Byrd et al., The Primary Correction of the Unilateral Cleft Nasal Deformity. Plast Reconstr Surg. 1985 Jun; 75(6):791-9). Our emphasis is on balancing the muscle forces on the lip and nose. We do not reposition the nasal septum. We do expect to perform a definitive rhinoplasty in the mid-teen years (age 15 to 16 for girls; age 16 to 18 for boys).