The Cleft Nose and Its Repair
How does a distort the nose, on the outside and on the inside, and when do we do the definitive repair?
💡 The same failed that split the lip unbalanced the nose inside and out, so the nose is a breathing problem as well as a shape problem, repaired definitively after growth.
Prerequisite check
- Surgery that repositions the jaw bones is called ; it corrects the Class III bite and the flat profile together by moving the forward.
- The is a planned cut across the that frees the whole upper jaw so it can be moved forward and fixed with plates.
What you will learn
Goal: Describe the (asymmetric ala, short or deviated , deviated septum) and explain why definitive rhinoplasty is timed to nasal growth.
- On the side the nostril is flattened and widened, the ala is pulled down and out, and the is short and leans toward the non-cleft side.
- Inside, the was deviated in about 92 percent of CL/P patients on CBCT, versus about 80 percent of non- controls.
- Sinus changes (mucosal thickening, smaller sinuses) and abnormal conchae are also more common in patients, so the cleft nose is also a breathing problem.
- Definitive is deferred until nasal growth is complete in the teen years, so later growth does not undo the repair.
Model: The outside and the inside of Mateo's cleft nose
On Mateo's side (the left), the nostril is flattened and widened, the rim of the nostril (the ala) is pulled down and outward, and the (the strip of skin and between the two nostrils) is short and leans toward the non-cleft side. This is the classic , present from birth because the same failed that split the lip also unbalanced the nose. Three-dimensional measurement studies confirm this and add a caveat: in cases the columella and tip are wider and the nasolabial angle is reduced, and the normal target shape differs by ancestry, so the surgeon should not use a single universal ideal.
A cone-beam CT scan looks inside the nose. In a 100-patient CBCT study, the (the wall dividing the two nasal passages) was deviated in 92 percent of CL/P patients versus 80 percent of non- controls, and abnormal conchae (the curled bones along the side wall) were also significantly more common in the cleft group. A second CBCT study found cleft groups had significantly higher rates of and maxillary sinus mucosal thickening, plus smaller sinuses, than controls.
Repair has two phases. A primary rhinoplasty is often done at the time of lip repair to reposition the alar , but the cartilage tends to relapse. The definitive (straightening the septum and refining the nose) is usually deferred until nasal growth is complete in the teen years, so the repair is not undone by later growth.
Explore (work the model before reading on)
- Name two ways Mateo's nostril rim and are out of place on the side.
- What percentage of CL/P patients had a deviated septum, and how does that compare with controls?
- The outside deformity and the inside come from the same original . Why would one event distort both the outer shape and the inner wall?
- A deviated septum narrows one nasal passage. Connect that to a symptom Mateo might report about breathing.
- The normal nose target differs by ancestry. Predict one problem that could result if a surgeon used a single universal ideal nose for every patient.
Guided notes
The outside
- The strip of skin and between the two nostrils is the ____, which is short and leaning on the side.
- The normal nose target differs by ____, so there is no single universal ideal shape.
The inside
- The wall dividing the two nasal passages is the nasal ____, deviated in about 92 percent of CL/P patients on CBCT versus about 80 percent of controls.
- A deviated septum and abnormal conchae can block airflow, so the nose is also a ____ problem.
Timing the repair
- Definitive ____ is deferred until nasal growth is complete in the teen years, so later growth does not undo it.
Reading the Research
- Skim the title and abstract first to get the gist.
- Circle the one sentence that states the main claim.
- Box the evidence the authors give for that claim.
- Mark one sentence that confuses you, and move on.
Vocabulary (the same words your classes use)
Vetted readings for this lesson
- Goksel & Ozcan 2023, CBCT Study of Osteomeatal Complex Variations in CLP (Cleft Palate Craniofac J)
- Paknahad et al. 2022, Maxillary Sinus Characteristics in CLP Using CBCT (Cleft Palate Craniofac J)
- Harrison et al. 2024, 3D Analysis of Racial and Ethnic Differences in Cleft Nasal Deformity (Cleft Palate Craniofac J)
Track your progress today
Check these off as you work through the lesson, then submit. This tells Mr. Mendoza how you're doing so he can help the class. It does not replace turning in your producible.
Use the code Mr. Mendoza gave you, not your name. Saved on this device.
- Read the Model and answered the Explore questions.
- Filled in the guided notes in my own words.
- Defined the new vocabulary with an example.
- Built the producible: Chart Mateo's nose. Sort four findings into "outside the nose" or "inside the nose": flattened left ala, deviated septum, short columella, thickened sinus lining. Then write one sentence recommending when to do his definitive septorhinoplasty and why that timing.
- Wrote my Claim, Evidence, and Reasoning exit ticket.
Exit ticket (Claim, Evidence, Reasoning)
- Claim: Mateo's affects both the outside and the inside of his nose.
- Evidence: Give one outside finding and one inside finding, with a number for the inside one.
- Reasoning: Explain why the same produces both, and why definitive nose repair waits until the teen years.
| Criterion | Proficient | Developing | Beginning |
|---|---|---|---|
| Complete | Every required part of the artifact is present and filled in. | Most parts are present, but one is missing or left blank. | Several parts are missing. |
| Accurate | The science and data are correct and match the evidence. | Mostly correct, with a small factual slip. | Key science or data is wrong. |
| Scientific reasoning (CER) | States a claim, backs it with specific evidence, and explains the reasoning. | Has a claim and evidence, but the reasoning is thin or missing. | Gives an answer with no evidence or reasoning. |
| Professional communication | Clear, organized, and labeled the way a clinician or scientist would write it. | Readable but disorganized or missing labels. | Hard to follow. |
| Submitted | Turned in the right way (Schoology for routine work) and confirmed. | Turned in, but in the wrong place or unconfirmed. | Not turned in. |
- CompleteProficient: Nothing is left blank: the model fills every part of "Chart Mateo's nose. Sort four findings into "outside the nose" or "inside the nose": flattened left ala, deviated septum, short columella, thickened sinus lining. Then write one sentence recommending when to do his definitive septorhinoplasty and why that timing.".
- AccurateProficient: Every number and claim matches the case evidence.
- Scientific reasoning (CER)Proficient: It names a claim, cites the specific evidence, and explains the reasoning, not just the answer.
- Professional communicationProficient: It is organized and labeled like a real chart note.
- SubmittedProficient: It would be turned in on Schoology and confirmed.
Where this leads: careers
What's next: We have now repaired lip, , bite, and nose. But some repairs do not fully hold. A hole can reopen in the roof of the mouth, and even a closed palate can let air leak into the nose during speech. What goes wrong after repair, and how is it fixed? We chase that next time.