The underlying pathology of the cleft lip nasal deformity has yet to be fully realized, and cleft lip rhinoplasty continues to challenge the reconstructive surgeon. A new model is proposed, which is composed of elements that represent known anatomical structures of the nose. These structures are considered elemental to the mechanism of the primary cleft lip nasal deformity. The lobule is reduced to four arches. Five points on the skull provide foundations for these arches, which react interdependently to extrinsic forces and positional change. When certain changes are imposed on the model, predictable alterations in the configuration of the model imitate the observed deformities in the spectrum of the cleft lip nasal deformity, unilateral and bilateral, mild through severe. The model is described with illustrations, anatomic dissection, physical models, and selected clinical cases. A better understanding of the mechanisms of the cleft nasal deformities can be obtained through analysis of the model. (Plast. Reconstr. Surg. 101: 1448, 1998.)
David M. Fisher, M.D.
76 Braeside Road
Toronto, Ontario, Canada
From the Grand Rapids Area Medical Education Consortium (GRAMEC) Plastic Surgery Residency, the Michigan State University College of Human Medicine and the Cleft Palate Clinics of The DeVos Children's Hospital/Butterworth Hospital and Blodgett Memorial Medical Center. Received for publication April 4, 1997; revised June 18, 1997.
Dr. David M. Fisher is presently a Craniofacial Surgery Fellow with Dr. Yu-Ray Chen, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
Presented at GRAMEC Research Day, in Grand Rapids, Michigan, on April 15, 1997, and at the Michigan Cleft Palate Association, in Detroit, Michigan, on May 30, 1997.