الفهرس 
Epidemiology and Etiopathogenesis of the Cleft Lip and PalateOnly 14 pages are availabe for public view
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Abstract
Cleft rhinoplasty forms one of the most challenging subsets of rhinoplasty patients because their cases are with high expectations and frustrations being have undergone multiple surgical procedures.
Although primary rhinoplasty improves nasal symmetry in patients with unilateral cleft lip deformity, this does not exclude the possibility of later revisional surgery. As a fact; small defects that are left after primary repair are amplified with the growth process and affect adjacent structures. It is accepted that patients who undergo appropriate primary repair for cleft lip will have secondary deformities
The cleft deformity is not restricted to the skin and cartilage. The nasal deformity can involve asymmetries and deficiencies of all of the components of the nose, including skin, mucosal lining, cartilage, and skeletal support.
The underlying skeletal support of the nose should ideally be addressed prior to definite rhinoplasty. Careful assessment of the skeletal base architecture can determine if alveolar bone grafting and/or LeFort I (maxillary) advancement are needed prior to definitive cleft rhinoplasty.
These skeletal procedures increase the projection and support of the lower third of the nose without significant alteration of the position of the nasal dorsum.
Modest augmentation of the premaxilla with onlay grafts can be performed at the time of definitive cleft rhinoplasty, but the bony foundation of the maxilla should ideally be established.
Correction of the cleft lip nasal deformity involves repositioning of the lower lateral cartilage on the cleft side to raise the dome, lengthening the columella and bringing it toward the midline, and correcting any asymmetries of the nasal floor. Additional structural support in the form of bone or cartilage grafts is often required in order to achieve the desired projection and angularity.
Correction of the hypoplastic lower lateral cartilage requires the use of a lateral crural strut graft and alar contour graft.
Correction of the tip deformity requires a columellar strut graft to provide tip projection, improve the lateral crus deformity, make the columellar-labial angle more obtuse, and provide a youthful fullness to the central lip.
Rib cartilage is preferred to septal cartilage as a source of grafts in cleft rhinoplasty because of its strength and ability to produce good, predictable results that are long lasting. Long-term follow-up indicates that these grafts maintain their volume and original features.
In spite of the difficulty in obtaining aesthetically pleasing and symmetrical results in cleft lip secondary rhinoplasty, patient satisfaction is high and comparable to the satisfaction in non-cleft rhinoplasty patients.
Although our sample is small, this study would assist in some preliminary conclusions. Management of some of the important features seen in the case of cleft rhinoplasty has been demonstrated and emphasized in our study.