Introduction: The complexity of the cleft nose deformity is caused by the inborn deformity of nasal structures prior to surgical procedures, the malposition or deformity of the paranasal bone and/or maxilla and additionally by scarring due to previous surgery.

The aim of the course is to outline a comprehensive algorithm for the surgical management of the cleft nose deformity which addresses the nasal structures as well as the accompanying skeletal deformity and jaw relation.

Patients and methods: The outlined algorithm is based on more than 400 cleft nose repairs, 312 septorhinoplasties in the age of skeletal maturity and 88 minor procedures in childhood and adolescence due to severe functional or aesthetic problems and columella lengthening procedures.

The following aspects of the cleft nose repair are addressed:
- Primary cleft nose repair – results and comprehensive review

- Clinical, radiological and endoscopic analysis of the cleft nose deformity with special emphasis on the deformity of septum, nasal structures and the malposition or deformity of the paranasal bone and/or maxilla

- Surgical planning (approach, transplants)

- Septoplasty

- Surgery of the dorsum and the pyramid

- Contouring of the tip

- Alar asymmetry

- Skeletal basis (

- In cases of maxillary retrusion with class III malocclusion a Le Fort I osteotomy with advancement of the maxilla was performed prior to septorhinoplasty. Before final septorhinoplasty removal of the plates must be completed.

- In cases with little nasal flatness or asymmetry with class I occlusion a regular septorhinoplasty was performed compensating the skeletal deformity of the maxilla by camouflage surgery.

- In cases with moderate to severe nasal flatness or asymmetry with class I occlusion an augmentation of the paranasal area with retromolar bone grafts to the piriform rim or diced cartilage in fascia was performed either in a single step or staged procedure.

Results: We did not see any infection or extrusion of cartilage or bone grafts. All patients with compromised nasal ventilation reported about improvement of nasal ventilation after surgery.

In 3% additional minor secondary procedures were performed.

Morphometric measurements demonstrated a significant improvement in all parameters, however minor remaining asymmetries were still seen depending on the degree of the initial deformity.

Conclusions: Complete analysis of the nasal functional and aesthetic deformity as well as analysis of the morphology of the paranasal area and occlusion are the key to successful management of the cleft nose deformity. Almost all patients benefit from cleft nose rhinoplasty in terms of function and aesthetics. Informed consent should initially include the information that additional minor secondary procedures may be helpful to improve the result.