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[Nasal sequels of unilateral clefts: analysis and management].
Rev Stomatol Chir Maxillofac 2007; 108(4):275-88RS

Abstract

Usually, the nasal sequels of unilateral cleft patient are just considered as an esthetic problem to be addressed after the growth spurt of adolescence. This very narrow vision has led the cleft lip and palate treatment to a deadend. Actually, nasal sequels are the worst in terms of consequence on facial growth. 75% of complete unilateral cleft children are more oral than nasal breathers. Today, we know about the bad consequences of oral breathing on facial growth. It is not surprising to observe a high rate of small maxilla with cleft maxilla scars. In the fetus, the unilateral cleft nose deformities are well explained by the rupture of the facial envelope and the ventilatory dynamics of the amniotic fluid. Every step of the primary treatment threatens the nasal air way patency, whether when repairing lip and nose, suturing the hard palate that is the floor of the nose, or closing the alveolar cleft which controls the width of the piriform aperture. The functional and esthetic nasal sequels reflect the initial deformity, but are also the surgeon's skill and protocol choice. Before undertaking treatment, we must analyze the deformity at every level. Usually, the best option is to reopen the cleft completely to perform a combined revision of the lip, nose, and alveolar cleft after an adequate anterior maxillary expansion. If nasal breathing is necessary for an adequate facial growth, 25 years of experience showed us that it was very difficult to erase the cortical imprint of an early oral breathing pattern. So it is essential to establish a normal nasal breathing mode at the initial surgery. When the initial surgery is efficient and/or the secondary repair is successful, the final esthetic rhinoplasty, when indicated, is just performed for the sake of harmonization, with a classic internal approach and a few refinements.

Authors+Show Affiliations

Clinique Jules-Verne, 2-4, route de Paris, 44300 Nantes, France. jeanclaude.talmant@libertysurf.frNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

17688895

Citation

Talmant, J-C, et al. "[Nasal Sequels of Unilateral Clefts: Analysis and Management]." Revue De Stomatologie Et De Chirurgie Maxillo-faciale, vol. 108, no. 4, 2007, pp. 275-88.
Talmant JC, Talmant JC, Lumineau JP. [Nasal sequels of unilateral clefts: analysis and management]. Rev Stomatol Chir Maxillofac. 2007;108(4):275-88.
Talmant, J. C., Talmant, J. C., & Lumineau, J. P. (2007). [Nasal sequels of unilateral clefts: analysis and management]. Revue De Stomatologie Et De Chirurgie Maxillo-faciale, 108(4), pp. 275-88.
Talmant JC, Talmant JC, Lumineau JP. [Nasal Sequels of Unilateral Clefts: Analysis and Management]. Rev Stomatol Chir Maxillofac. 2007;108(4):275-88. PubMed PMID: 17688895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Nasal sequels of unilateral clefts: analysis and management]. AU - Talmant,J-C, AU - Talmant,J-Ch, AU - Lumineau,J-P, Y1 - 2007/08/03/ PY - 2007/06/08/received PY - 2007/06/15/accepted PY - 2007/8/11/pubmed PY - 2007/12/21/medline PY - 2007/8/11/entrez SP - 275 EP - 88 JF - Revue de stomatologie et de chirurgie maxillo-faciale JO - Rev Stomatol Chir Maxillofac VL - 108 IS - 4 N2 - Usually, the nasal sequels of unilateral cleft patient are just considered as an esthetic problem to be addressed after the growth spurt of adolescence. This very narrow vision has led the cleft lip and palate treatment to a deadend. Actually, nasal sequels are the worst in terms of consequence on facial growth. 75% of complete unilateral cleft children are more oral than nasal breathers. Today, we know about the bad consequences of oral breathing on facial growth. It is not surprising to observe a high rate of small maxilla with cleft maxilla scars. In the fetus, the unilateral cleft nose deformities are well explained by the rupture of the facial envelope and the ventilatory dynamics of the amniotic fluid. Every step of the primary treatment threatens the nasal air way patency, whether when repairing lip and nose, suturing the hard palate that is the floor of the nose, or closing the alveolar cleft which controls the width of the piriform aperture. The functional and esthetic nasal sequels reflect the initial deformity, but are also the surgeon's skill and protocol choice. Before undertaking treatment, we must analyze the deformity at every level. Usually, the best option is to reopen the cleft completely to perform a combined revision of the lip, nose, and alveolar cleft after an adequate anterior maxillary expansion. If nasal breathing is necessary for an adequate facial growth, 25 years of experience showed us that it was very difficult to erase the cortical imprint of an early oral breathing pattern. So it is essential to establish a normal nasal breathing mode at the initial surgery. When the initial surgery is efficient and/or the secondary repair is successful, the final esthetic rhinoplasty, when indicated, is just performed for the sake of harmonization, with a classic internal approach and a few refinements. SN - 0035-1768 UR - https://www.unboundmedicine.com/medline/citation/17688895/[Nasal_sequels_of_unilateral_clefts:_analysis_and_management]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0035-1768(07)00152-0 DB - PRIME DP - Unbound Medicine ER -