Technique in Cleft Rhinoplasty: The Foundation Graft

Overview

Secondary cleft rhinoplasty is difficult because the skeleton beneath the nose is deficient on the cleft side, not only the soft tissue above it. The authors identify shortfall in projection of the cleft-side piriform rim as an important contributor, and describe building that rim up as the foundation for the rest of the correction.

Sections of note

• The article is a technique description with a retrospective series of five cases.
• A graft is used to augment the piriform crest on the cleft side.
• It is fixed with sutures to the piriform crest after all soft tissue attachments to the alar base are released.
• The foundation graft is articulated with a long alar strut graft, which the authors state allows powerful projection of the cleft-side nasal tip.
• An advancement flap of skin from inside the nostril is described for correcting narrowing of the nostril entrance.
• Diced cartilage in fascia is added to build up soft tissue volume over the upper jaw. Subjective and objective measures of form and function are presented for the five cases.

What it means for a patient

• The approach treats the underlying bone deficiency first, rather than only reshaping the cartilage and skin above it.
• Releasing the soft tissue from the nostril base is what allows the nose to be repositioned rather than merely padded.
• The technique addresses three problems together: skeletal support, a narrowed nostril entrance, and hollowness beside the nose.
• Five cases, reviewed retrospectively, with no comparison group and no follow-up duration stated, so this demonstrates feasibility rather than measured effectiveness.

Why this paper matters

Cleft nasal deformity persists into adulthood because the supporting skeleton is short, and soft tissue techniques alone do not correct that. Naming the piriform rim as the foundation reframes where the operation should start. With five cases and no stated follow-up, durability is unaddressed.

Terms

• Secondary cleft rhinoplasty: surgery to reshape the nose after an earlier cleft lip repair.
• Piriform rim or crest: the bony edge of the pear-shaped nasal opening in the skull.
• Alar base: the point where the nostril wing meets the face.
• Alar strut graft: cartilage placed to support and project the nostril wing.
• Vestibular stenosis: narrowing of the entrance inside the nostril.
• Diced cartilage in fascia: chopped cartilage wrapped in connective tissue and used to add volume.