title: Nasal tip complications of primary cleft lip nasoplasty.
abstract: OBJECTIVE
  Complications of primary nasoplasty, at the time of definitive primary cheiloplasty, are underreported in the literature. This study endeavors to examine the occurrences of these complications at our cleft-craniofacial center, in an effort to identify causative factors and management strategies. A case series of patients with postoperative nasal complications after primary cleft lip nasal surgery is presented.
  
  
  METHODS
  A retrospective chart review of primary cleft lip nasal repairs was conducted at our cleft-craniofacial center between January 2003 and December 2007. Consecutive cases of 3 staff surgeons were evaluated. Specific data points included number and type of complications, subsequent required interventions, and relevant history, with particular attention paid to the details of the primary nasoplasty.
  
  
  RESULTS
  Eighty-six primary cleft lip nasoplasties were completed between the years 2003 and 2007. Six complications (6.9%) related to the primary cleft lip nasoplasty were identified. Four patients (4.6%) experienced nasal tip infections; all 4 required surgical drainage. Twenty-four patients (27.9%) undergoing primary cleft lip and nose repair had postoperative nostril conformers placed, and 2 (8.3%) of them experienced complications deemed conformer related.
  
  
  CONCLUSIONS
  Postoperative nasal complications of primary cheiloplasty occur and are likely underreported. In this series, complications resulted from infection, often occurring late, and secondary to the use of nostril conformers. Surgeon awareness and caregiver education, to identify the early signs of postoperative nasal complications, are critical to the successful treatment of these occurrences. Although this study did not intend on examining antibiotic use, the significance of nasal tip infections might support the regular use of antibiotics in this population, and the use of postoperative nostril conformers must be followed closely.
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh Cleft-Craniofacial Center, University of Pittsburgh, 45th St and Penn Ave., Pittsburgh, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Alef
authors.forename: Chetan
authors.initials: C
authors.lastname: Irwin
authors.forename: Darren
authors.initials: D
authors.lastname: Smith
authors.forename: Ahmed
authors.initials: A
authors.lastname: Afifi
authors.forename: Shao
authors.initials: S
authors.lastname: Jiang
authors.forename: Lisa
authors.initials: L
authors.lastname: Vecchione
authors.forename: Matthew
authors.initials: M
authors.lastname: Ford
authors.forename: Gary E
authors.initials: GE
authors.lastname: Decesare
authors.forename: Frederic W-B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D000038:Abscess / Q000382:microbiology; D002971:Cleft Lip / Q000601:surgery*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000175:diagnosis; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery; D009666:Nose / Q000601:surgery*; D009668:Nose Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis; D053831:Surgical Fixation Devices / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques