Cleft Nasal Anatomy
Patients with cleft lip have characteristic changes in the appearance of the nose that can cary dramatically from person to person. The width of the gap in the cleft of the lip impacts the severity of the changes in the nasal appearance. When the gums and palate are involved in the cleft the separation in the bones creates a wide gap that separates the lip segments and drastically changes the shape of the nose. The next images illustrate some important anatomy of the nose in areas that are affected by clefts of the lip.
The figure above shows the normal nasal tip which is symmetric and round. The ala (outer part of the nostril) is also rounded and symmetric. The nasal floor is skin at the bottom of the nostril where the lip and nostril meet.
In complete cleft lip and palate the cleft extends up through the entire height of the lip and through the nasal floor (bottom of the nostril). The cleft continues back through the bone in the upper jaw including the gums and the entire length of the palate. While the features of the cleft lip alone are striking, the involvement of the underlying bone including the gums and palate creates significant changes in the facial skeleton that adds to the asymmetry of the face. These facial bones are the foundation that the nose sits on. Clefts involving the gums (alveolus) and palate create a large step off in the bony foundation causing deformity of the nose.
As you can see in the figure above, the degree to which the nose is deformed by the cleft of the lip relates to the width of the cleft of the lip. For the nose, the involvement of the gums and palate has the most dramatic effect on the nasal shape. This is because the cartilage and skin of the nostril (ala) is shaped like an upside down U with the ends of the U sitting on the facial bones on each side of the cleft. The farther away the ends of the cartilage are from one another, the more severe the changes in the shape of the nose will be.
Patients with bilateral cleft lip and palate have symmetric but more severe changes in the appearance of the lip and nose because the separation in the bones of the gums and palate creates a wide gap that separates the lip segments and drastically changes the shape of the nose.