Cleft Nasal Anatomy
Cleft nasal deformity is the medical term used to describe the characteristic changes in the shape and appearance of the nose that occur due to cleft lip and palate. Cleft lip results in an abnormal shape and position of the nasal septum and nasal tip cartilages that creates an uneven appearance of the nostril, nasal tip and deviation of the nasal septum.
In addition to an uneven appearance of the nose, these changes frequently cause breathing difficulties during childhood. The width of the gap in the cleft of the lip impacts the severity of the changes in the nasal appearance. When the gums and palate are involved in the cleft the separation of the gums creates a wide gap that stretches the nostril on the cleft side. The next images illustrate some important anatomy of the nose in areas that are affected by clefts of the lip followed by images of the changes that occur in the nose due to unilateral and bilateral cleft lip. Cleft rhinoplasty for teenagers and adults is covered in the cleft rhinoplasty page and adult cleft rhinoplasty page.
In complete cleft lip and palate the cleft extends through the entire height of the lip and through the nasal floor (bottom of the nostril). The cleft continues back through the bone in the gums and the entire length of the palate. While the features of the cleft lip alone are striking, the involvement of the gums and palate creates a wide separation of the gums that stretches the cartilage and skin of the nostril on the cleft side, causing a very uneven appearance to the nose.
The degree to which the nose is deformed by the cleft of the lip relates to the width of the cleft of the lip. For the nose, the involvement of the gums and palate has the most dramatic effect on the nasal shape. This is because the cartilage and skin of the nostril (ala) is shaped like an upside down U with the ends of the U sitting on the facial bones on each side of the cleft. The farther away the ends of the cartilage are from one another, the more severe the changes in the shape of the nose will be.
Patients with bilateral cleft lip and palate have symmetric but more severe changes in the appearance of the lip and nose because the separation in the bones of the gums and palate creates a wide gap that separates the lip segments and drastically changes the shape of the nose.
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The figure above shows the normal nasal tip which is symmetric and round. The ala (outer part of the nostril) is also rounded and symmetric. The nasal floor is skin at the bottom of the nostril where the lip and nostril meet.
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The columella is the skin and cartilage that separates the two nostrils and supports the nasal tip. The ala (outer part of the nostril) is also rounded and symmetric.
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In the figure above the location where unilateral cleft lip and palate occurs is marked in blue. Complete unilateral cleft lip and palate causes a separation in the lip gums and palate. The wide separation of the gums and the significant affect on the nasal shape can be appreciate in the photo on the right.
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Complete Bilateral Cleft Lip and Palate results in a symmetric but severe changes in the nasal shape due to the separation of the gums and primary palate.
