**1. Introduction**

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241-57.

15:49-50.

Among facial esthetic surgeons, secondary rhinoplasty in adult cleft –nose deformities is considered to be one of the most challenging surgical interventions due to the congenital distortion of the cartilaginous and bony nasal pyramid, which compromises both nasal esthetics and function. It is generally accepted that the cleft-lip nasal deformity (CLND) is challenging; It is attempted to do this either at the time of primary rhinoplasty in the early of age with repair of lip or by secondary rhinoplasty later on in life. CLND may vary from minor to severe deformity. Several techniques have been suggested and plenty of articles have discussed this issue but still there is no consensus on an optimal technique to manage all of the problems. The common techniques that we use in routine rhinoplasty may not yield good results in patients with CLND, and the reasons for that are:


The clinical presentation of cleft nose deformities varies widely, requiring a full knowledge of surgical techniques; if deformity is severely asymmetric surgical correction is much more difficult. The clinical features of deformity in a unilateral cleft nose differ from that usually seen in bilateral CLND. The scenario of rhinoplasty in surgical techniques in bilateral CLND is entirely different from unilateral CLND. It seems complete correction of all deficiencies of some noses remain an intangible goal for many, and this is the reason why revision rhinoplasty is commonly needed in these patients. Furthermore, it should be noted that each patient with

CLND presents a unique challenge due to complexity and combination of aspects and certain techniques that may be more suitable than others in individual cases [1, 2].
