Anatomy of the Bilateral Cleft Lip Nasal Deformity and Its Correction

This webinar was originally accepted as a Teaching Course for ACPA's 77th Annual Meeting.


The nasal deformity of the bilateral cleft lip is an intrinsic component of the deformity. Uncoupling of the orbicularisoris sphincter results in lateral displacement of the alar bases and protrusion of the premaxilla and prolabium.Additionally, the medial crura of the lower lateral cartilages are splayed with the fibro-fatty tissue of the nasal tipintervening between the tip defining points of the middle crura, resulting in an underprojecting nasal tip andshortened columella. Synchronous repair of the nasal deformity at the time of primary cheiloplasty is essential fortreatment of the condition, as cheloplasty and delayed nasal repair results in secondary stigmata including a wide,underprojecting nasal tip, short or non-existent columella, and flaring of the nasal ala. The aim of this presentation is to describe the anatomy of the bilateral cleft nasal deformity, and to discuss surgical approaches to its correctionincluding the role of presurgical infant orthopedics and strategies for treating asymmetric bilateral clefts.


Anatomic studies of nasal anatomy in the setting of bilateral cleft lip will be reviewed along with a brief overview of thehistory of staged repair techniques for bilateral clefts. The authors will present an overview of techniques forsynchronous bilateral cleft lip and nasal correction with specific attention given to the Mulliken technique ofsynchronous bilateral cleft lip repair. Outcome studies of various techniques will be discussed as well as the role ofpresurgical infant orthopedics in treating bilateral clefts and the role of cleft lip adhesion for optimizing outcomes in anasymmetric bilateral cleft lip.


A comprehensive primary surgical repair of the bilateral cleft lip nasal deformity is a safe and achievable goal. Keysteps are surgical and/or orthopedic repositioning of the premaxilla, adequate medialization of the alar bases,reconstruction of the orbicularis sphincter, reconstruction of the nasal floor, and unification of the middle crura of thelower lateral cartilages under direction visualization. Presurgical infant orthopedics is an important adjunct treatmentfor patients with complete clefts as is lip adhesion for patients with asymmetric bilateral clefts.

Continuing Education 

Attendees must register, attend and evaluate each webinar to receive continuing education credit. This on-demand course will be eligible through March 31, 2022. 

  • ACCME: ACPA designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™.  Physicians should only claim credits commensurate with the extent of their participation in the activity. The American Cleft Palate-Craniofacial Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Nursing: This nursing continuing professional development activity was approved by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

To receive 1.0 contact hours:

  • Learners must attend 80% or more of the webinar.
  • Learners must complete and submit an evaluation form.

Neither the speakers nor members of the planning committee have any conflicts of interest related to the content of this activity.  Individual disclosures may be found in the “Topics” tab under their name. 

Original Seminar Date: October 13, 2020

On-Demand Release Date: October 14, 2020

On-Demand Expiration Date: March 31, 2022

Seminar Objectives
  • Learners will be able to describe the anatomic factors that contribute to the bilateral cleft lip nasal deformity andunderstand the secondary deformities created by cleft lip correction alone and staged nasal corrections usingrecruited labial tissue for columellar lengthening.
  • Learners will be able to describe common techniques for primary correction of the bilateral cleft lip nasal deformity.
  • Learners will understand the importance of preoperative dentofacial orthopedics for optimizing outcomes inbilateral cleft lip correction.
  • Learners will be able to describe an approach to correction of asymmetric bilateral cleft lips.
Seminar Information
Expiration Date:
September 13, 2022 11:55 PM
55 minutes
ACPA Life Member Price:
Transitional Member Price:
Student Non-member Price:
Student Member Price:
Member Price:
ACPA Retired Price:
ACPA Member Price:
Full Price:
Part 1
Speaker Information
Kamlesh Patel  [ view bio ]
Part 2
Speaker Information
Stephen Alex Rottgers  [ view bio ]
Individual topic purchase: Selected
AMA PRA Category 1 Credit(s)™: 1.00
Nursing Contact Hours: 1.00
Accreditation Council for Continuing Medical Education (non-MD/DO)
AMA PRA Category 1 Credit(s)™: 1.00
On-Demand Access Only
Student Non-member: $14.99
Student Member: $14.99
Member: $14.99
ACPA Retired: $14.99
ACPA Member: $14.99
ACPA Life Member: $14.99
Transitional Member: $14.99
Full Price: $24.99