Primary Rhinoplasty in Unilateral Cleft Lip

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the embryologic and anatomical basis of the nose in a unilateral cleft lip. 2. Identify key challenges in achieving nasal symmetry and balance in cleft rhinoplasty coinciding with primary lip reconstruction. 3. Evaluate the advantages and limitations of different surgical approaches to the nasal tip, including open, closed, and conservative techniques. 4. Recognize the role of septoplasty, alar base repositioning, and nasal tip manipulation in improving outcomes. 5. Appreciate the importance of postoperative management and the commitment to systematically documenting and analyzing long-term results. SUMMARY: The nose, associated with a unilateral cleft lip, presents a complex surgical challenge, requiring a precise understanding of nasal anatomy and cleft-related distortions. Primary cleft rhinoplasty aims to restore nasal symmetry by repositioning the alar base, centralizing the columella, improving tip projection, and minimizing tissue trauma and growth impairment. This article reviews the embryologic and anatomical basis of the unilateral cleft lip and nose; highlights key challenges in correction; and examines the impact of different surgical techniques, including open, closed, and conservative approaches. The role of septoplasty, alar base repositioning, and tip manipulation is analyzed, along with the importance of consistent postoperative care and outcome monitoring to achieve long-term symmetry and functional success. This review provides a structured framework to guide surgical decision-making and optimize long-term outcomes in cleft rhinoplasty.