At What Age Should Rhinoplasty be Done In Bilateral Cleft Lip And Palate?
Q: Dr. Eppley, my son was born with a bilateral cleft lip and palate. He just turned 9 years old. He is about to get his bone graft surgery in December. What is too early to have nose reconstruction? The surgeons said he would rather not touch his nose until he is age 15 or 16.
A: The nose deformity in bilateral cleft lip and palate is uniquely different from even that of a unilateral cleft. The lack of columellar skin and weak and short tip cartilages poses a significant reconstructive challenge that is present at any age that a patient undergoes any form of a rhinoplasty.
It is best to think of the nose reconstruction in bilateral clefts as done in stages. There are many variations as to how it is approached and will vary by surgeon. Fundamentally, it is divided into stages based on age and development. Under 12 years of age, the focus is on columellar lengthening, nostril narrowing and/or tip cartilage manipulation. After the age of 12, a full septorhinoplasty is done where the entire nose is reconstructed from the nasal bones down to the tip cartilages including the septal and turbinate deformity. At what age this full septorhinoplasty is done is open to debate but most plastic surgeons think more around the age of 14 or 15 years old when the face is essentially fully developed. There may be some modifications to this age based on the extent of the nasal deformity and the timing of orthognathic surgery (LeFort osteotomy) if needed.
In short, major manipulations of the septum and nasal bones should not be done under the face is more fully developed.
Dr. Barry Eppley