Secondary Narrow Nostril Deformity After Unilateral Cleft Lip Repair: Etiology, Classification, and Surgical Strategies

Abstract

Secondary narrow nostril deformity after unilateral cleft lip repair remains a stubborn clinical challenge, with an incidence of approximately 84%. It compromises both nasal airway function and facial esthetics. The etiology is multifactorial, involving congenital tissue deficiencies, abnormal orbicularis oris insertion, and iatrogenic deformities resulting from primary repair. Current reconstructive approaches can be broadly categorized into tissue augmentation, structural reinforcement, and contour-modifying strategies, with postoperative nasal retainers serving as a key adjunct device. Although studies have suggested benefits in improving nasal symmetry and airway patency, variability in surgical indications and outcomes has hindered the establishment of a unified consensus. The authors provide an overview of current surgical strategies and postoperative management for secondary narrow nostril deformity, aiming to support more precise treatment planning and improved surgical results.