What happens during surgery and recovery?
As mentioned previously, cleft patients have noses that form abnormally and cartilage that is usually very weak. We do as much as we can to fix the nose at the time of the initial lip repair. However, it is not possible to use many of the techniques necessary to improve these deformities on a baby. In most cases, the cartilage must be strengthened and repositioned, the bones need to be broken, and part of the septum needs to be removed to straighten it. In general, it is best to do all of these things once your child is done with growth at 16-18 years of age. The best results are achieved the first time that you operate on the nose. Additionally, the septum is considered to be a growth center of the face. Most surgeons would not recommend performing significant work on the septum before puberty. Generally, if we know that your child is going to require jaw surgery, we also like to wait till the orthognathic surgery is completed before doing the rhinoplasty. However, in instances where the nose is significantly deformed, and is causing problems with self-confidence, school, and socializing, we might consider performing surgery earlier. If the social benefits would be significant, we may even consider doing a more limited surgery in younger children. This is what some might call the “kindergarten rhinoplasty”. For young children, we only work on the tip of the nose, so it is possible that your child would need a more formal rhinoplasty as an adult. In general, a rhinoplasty can make a significant improvement in your child’s appearance, and most are extremely happy with the results. However, it will never be possible to make the nose look completely normal or symmetric. It is important that you help your child set realistic goals for surgery.
During surgery, we make most of the incisions inside the nostrils where they are hidden, and one small incision along the columella. The skin is then lifted off of the cartilage, and we usually remove a large piece of cartilage from the septum. The septum is then straightened and, if necessary, the bones are broken and straightened as well. We usually need to add a number of cartilage grafts in different places to strengthen the nose, shape the nose, and give it projection. These are sewn in place. There are several possible sources for the cartilage grafts. First, is the cartilage that we remove from the septum. However, in cleft patients, the septum is usually small, and there is rarely enough cartilage available. The next option is cartilage from the patient’s own ear or rib. These are excellent choices, but removing the cartilage can be quite painful, and leave additional scarring. This is why we tend to use MTF cadaver rib cartilage. MTF has been used in rhinoplasty for many years with excellent results, and is widely available. It is processed so that there are no immune cells left in the tissue, and otherwise acts like your body’s own cartilage. Once all the cartilage is shaped, and grafts are placed, the skin is sutured closed.
As mentioned previously, cleft patients have noses that form abnormally and cartilage that is usually very weak. We do as much as we can to fix the nose at the time of the initial lip repair. However, it is not possible to use many of the techniques necessary to improve these deformities on a baby. In most cases, the cartilage must be strengthened and repositioned, the bones need to be broken, and part of the septum needs to be removed to straighten it. In general, it is best to do all of these things once your child is done with growth at 16-18 years of age. The best results are achieved the first time that you operate on the nose. Additionally, the septum is considered to be a growth center of the face. Most surgeons would not recommend performing significant work on the septum before puberty. Generally, if we know that your child is going to require jaw surgery, we also like to wait till the orthognathic surgery is completed before doing the rhinoplasty. However, in instances where the nose is significantly deformed, and is causing problems with self-confidence, school, and socializing, we might consider performing surgery earlier. If the social benefits would be significant, we may even consider doing a more limited surgery in younger children. This is what some might call the “kindergarten rhinoplasty”. For young children, we only work on the tip of the nose, so it is possible that your child would need a more formal rhinoplasty as an adult. In general, a rhinoplasty can make a significant improvement in your child’s appearance, and most are extremely happy with the results. However, it will never be possible to make the nose look completely normal or symmetric. It is important that you help your child set realistic goals for surgery.
During surgery, we make most of the incisions inside the nostrils where they are hidden, and one small incision along the columella. The skin is then lifted off of the cartilage, and we usually remove a large piece of cartilage from the septum. The septum is then straightened and, if necessary, the bones are broken and straightened as well. We usually need to add a number of cartilage grafts in different places to strengthen the nose, shape the nose, and give it projection. These are sewn in place. There are several possible sources for the cartilage grafts. First, is the cartilage that we remove from the septum. However, in cleft patients, the septum is usually small, and there is rarely enough cartilage available. The next option is cartilage from the patient’s own ear or rib. These are excellent choices, but removing the cartilage can be quite painful, and leave additional scarring. This is why we tend to use MTF cadaver rib cartilage. MTF has been used in rhinoplasty for many years with excellent results, and is widely available. It is processed so that there are no immune cells left in the tissue, and otherwise acts like your body’s own cartilage. Once all the cartilage is shaped, and grafts are placed, the skin is sutured closed.
There will be some stitches that have to be removed in the office in 5-7 days. We will also place splints in the nose, and on top of the nose that will be removed in the office in 5-7 days. While the splints are in place, the nose should be kept dry. Your child will feel like they are congested and it is hard to breathe through the nose. You can clean the nostrils gently with a q-tip if necessary. Your child should not blow their nose, and should try to sleep propped up on pillows. Bloody drainage will be normal for the first week or so, and the face and eyes may swell or look bruised. You will be able to go home the same day as surgery, and your child may return to school whenever they feel ready. They will have to refrain from sports, heavy exercise or gym class for 6 weeks. We will have you come to the office in 5-7 days to have the sutures and splints removed. The nose will be very swollen at first. Most of this will go away in the first few months, but it generally takes a full year before you will see the final results from surgery. The nose will also feel very firm due to the cartilage grafts.
