Nasal Light Reflex: A Useful Intraoperative Tool in Correction of Cleft Lip Nasal Deformity

Background: The correction of a unilateral cleft lip nasal deformity remains a challenge to cleft surgeons. It is difficult to obtain a routinely predictable outcome. This is in part due to there being no objective intraoperative method to assess the correction. Methods: We have come up with a simple objective intraoperative method to plan and assess the correction of the nasal deformity. This is done by assessing the nasal light reflex using a mobile phone camera to define the deformity. The points of the desired correction of the lower lateral cartilage are transposed onto the patient. Once the lip and nose repair is completed, another photograph is taken to assess the nasal light reflex and assess the extent of correction. If this is inadequate, further nasal correction is performed. We have used this procedure in 122 cleft lip patients with 93 complete and 29 incomplete. Results: We have found this to be a useful objective intraoperative method to assist in obtaining improved nasal correction in cleft lip patients. As is well known, relapse of the nose is common in cleft lip repairs, but this method allows one to better gauge the correction at the primary surgery. Conclusion: Nasal light reflex should be added to the armamentarium of cleft surgeons to assist in superior correction of the nose, which is an item that continues to vex these surgeons.