**5. Non-surgical treatment**

consists of a careful examination of the bony and cartilaginous skeleton, anterior rhinoscopy evaluating the appearance of the nasal mucosa and the position of the anterior part of the septum is necessary. The problems present in a patient with a cleft lip nasal deformity must be recognized just as any other rhinoplasty patient and clearly defined in order to formulate

**e 4: Preoperative views A: Frontal view B: lateral view**

In order to treat CLND, clinical diagnosis and complete knowledge of

anatomy, pathology and physiology of the nasal pyramid, maxilla, and lip is

imperative. Clinical examination consists of a careful examination of the

bony and cartilaginous skeleton, anterior rhinoscopy evaluating the

appearance of the nasal mucosa and the position of the anterior part of the

septum is necessary. The problems present in a patient with a cleft lip nasal

deformity must be recognized just as any other rhinoplasty patient and

clearly defined in order to formulate a successful treatment plan. In fully

Significant improvement in growth , function and esthetics has been

achieved by almost normal reconstruction of alveolar clefts .To establish

the nasal skeletal base , three dimensional reconstruction of alveolar

defects with bone grafting has been advocated by clinicians; different

approaches at the different stages of life have been suggested [**Figure 4**].

Significant improvement in growth, function and esthetics has been achieved by almost normal reconstruction of alveolar clefts.To establish the nasal skeletal base, three dimensional reconstruction of alveolar defects with bone grafting has been advocated by clinicians;

Proper jaw relationship plays an important role in the skeletal base of the nose; obviously, final rhinoplasty must be postponed until completion of orthognathic surgeries. Although some authors suggested performing orthognathic surgery on growing cleft patients when mandated by psychological and / or functional concerns; but, because of postsurgical outcome the consensus of most clinicians is to delay orthognathic surgery until growth is completed. Different kinds of distraction procedures such as intraoral and extraoral devices may be used as an alternative to the orthognathic approaches in cleft patients; a proper position of the maxilla is mandatory before performing rhinoplasty in adults with cleft lip and nose deformity. Supposedly, the skeletal support enhances the projection of the lip and nose on the cleft side.

CT scan of paranasal sinuses in axial and coronal views may be helpful to define the defor‐ mation of the septum as well as other intranasal structures. It is important to identify both aesthetic and functional problems associated with the cleft nose deformity. Each component

different approaches at the different stages of life have been suggested (Figure 4).

a successful treatment plan. In fully grown adult we need to evaluate:

grown adult we need to evaluate:

1‐The nose and lip

790 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

2‐ Midface deficiency

**Figure 5.** Intraoperative view of 3D reconstruction of alveolar cleft

3‐ Oro‐ nasal fistula

4‐Occlusion and

**1.** The nose and lip

**2.** Midface deficiency

5‐ Speech.

**4‐ Diagnosis**

**3.** Oro- nasal fistula

**4.** Occlusion and

**5.** Speech.

Before correction of the soft tissues, it is important to make sure if there are any dental problems that needs to be corrected first. Soft tissue correction before dental treatment can result in very embarrassing situation that may not be correctable later [22].
