Rinocheilognatoschisi monolaterale: approccio globale alla dismorfia della punta nasale

The correction of nasal tip deformities, always combined with cleft lip, so that some authors the prefere the term rynocheilognatoschisis, is one of the most difficult and controversial issues in plastic surgery procedures for face malformation.The nose is a crucial feature in the harmony of the face and there is a vast literature on the numerous surgical corrective techniques, concerning both methodologies and timing. As a regards the time of correction we divide rhinoplasty into: primary rhinoplasty, performed at the time of primary lip surgery repair, intermediate rhinoplasty, performed between first and second childhood and final rhinoplasty, performed after completion of the development of the face. The purpose of this paper is to describe the pathological anatomy of nasal deformities in unilateral rinocheilognatoschisis and to illustrate the global methodology implemented by the Bologna school, made up of three distinct phases of treatment: pre-surgical modeling, surgery and post-surgical shaping.It aims to describe how the treatment of nasal deformities combined with cleft lip has been developed in the Bologna school over the last twenty years, through the analysis of functional and aesthetic results achieved in the treatment of 70 clinical cases, from 1988 to data, in the Center for Dismorphopaties Plastic Surgery/Center for the Treatment of Malformations.The main objective of the article is to compare the results achieved through the global technique with those obtained through the merely surgical traditional procedure used in the past.On the basis of the data obtained we can conclude that an early use of pre-surgical procedures and of their surgical variant currently applied in the Bologna school has allowed to achieve very good both on functional and aesthetic level. These procedures have actually resulted in a series of short and long term benefits, which mainly concern the correction of nose/lip/ labial deformities, and have significantly reduced complexity and invasiveness of secondary corrective surgery, which can thus be performed on a more stable and symmetric background. Finally they have also reduced the price to be paid in terms of residual scars, length of stay in hospital and surgery morbidity. These results are optimized by Psychological Assistance that influence in determining the future life in terms of adaptation and social interaction, appearance, self-esteem, emotional conditioning, behavioural and even cognitive, conditioning therefore, in a positive way, the quality of life of young patients and their families.