الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cleft lip nasal deformity represents formidable challenge for any plastic surgeon. It’s a complex deformity that involves all tissue layers including the skin, cartilage, vestibular lining and skeletal platform. This deformity varies with the degree of lip abnormality. It may be unilateral or bilateral and incomplete or complete. The unilateral type puts the surgeon under stress trying to bring the deformed side aesthetically equal to the normal side. Cleft rhinoplasty is divided into three stages; primary, intermediate and secondary rhinoplasty according to the timing of the surgical intervention. Accordingly primary rhinoplasty is performed with cleft lip repair around 3 months of age. While intermediate rhinoplasty is performed during the most critical period of psycho- social development between 4 to 12 years, preferably between 4 and 6 years old, before the school, so called preschool rhinoplasty. Lip revision can be performed also with intermediate rhinoplasty. Secondary or definitive rhinoplasty is generally performed after completion of facial growth (14 – 16 years for females, while 16-18 years for males). Intermediate cleft rhinoplasty addresses the severely asymmetrical nasal tip that didn’t be repaired in primary rhinoplasty, the shortened columella, any residual defects in lower lateral cartilage and lateral vestibular webbing. However, septal surgery and cartilage grafting don’t be performed at this stage, they are postponed until complete skeletal growth is achieved. According to our intermediate cleft rhinoplasty technique, we can harvest septally based adipofacial flap from non-cleft to cleft side as a new idea to augment and correct tip asymmetry, compensate the shortening of pronasale to subnasale distance and maintain new medial position of the corrected lower lateral cartilage in unilateral cleft lip nasal deformity. Intermediate cleft rhinoplasty is valuable, allowing the nose to grow in symmetrical manner and decreasing the need to secondary rhinoplasty, also to aleviate the socio-psychological disorders in the children with cleft lip nasal deformity at this age.