Unilateral Cleft Lip Nasal Deformity: Foundation-Based Approach to Primary Rhinoplasty

Overview

Most primary cleft rhinoplasty focuses on repositioning the tip cartilages, but the deformity recurs often and revision is common. The authors describe an alternative that corrects the disrupted base and leaves the tip undissected, and assessed how the result held through growth using 3D imaging.

Sections of note

• 102 consecutive patients undergoing repair were assessed.
• Images were captured before surgery, after surgery, and at 5 years of age where available, using three-dimensional stereophotogrammetry.
• Standard anthropometric plus shape-based analysis was used: volume ratio, dorsal deviation, and alar-cheek definition.
• Age-matched normal control subjects provided comparison images.
• Significant changes in both anthropometric and morphometric measurements occurred with surgery.
• Postoperative form was similar to controls both immediately after surgery and at 5 years; only two patients elected revision.
• Comparing different methods of nasal sidewall reconstruction or septoplasty showed no differences.
• Alveolar cleft width significantly predicted worse form both before and after surgery. Level of evidence IV, therapeutic.

What it means for a patient

• The correction was achieved without operating on the tip cartilages, which the authors say preserves tissue planes for any later revision.
• The result matched unaffected children's noses immediately and still did at age 5.
• The width of the gum cleft predicted how good the result would be, before and after.
• Limits: not randomized, one center, comparison to normal controls rather than to an alternative technique, and follow-up to age 5 rather than through adolescent growth.

Why this paper matters

Recurrent deformity and repeated revision are the defining problems of cleft rhinoplasty, and this reports only two revisions in 102 children. Shifting the target from the tip cartilages to the foundation is a substantive change in approach. Whether the result holds through puberty is not yet answered.

Terms

• Nasal foundation: The bony and soft tissue base on which the nose sits.
• Lower lateral cartilage: The paired cartilage forming the nasal tip and nostril rim.
• Three-dimensional stereophotogrammetry: Building a 3D surface model from multiple simultaneous photographs.
• Alveolar cleft: A gap in the bone of the upper gum, part of a cleft lip and palate.
• Anthropometric analysis: Measurement of body or facial dimensions.