Component Restoration in the Bilateral Intermediate Cleft Tip Rhinoplasty

Overview

Intermediate cleft tip rhinoplasty is performed in childhood to correct nasal tip abnormalities before the key period of social development. The authors had previously described a component restoration technique for the one sided cleft nose, addressing deficient lining, misplaced tip cartilage and weak lateral cartilage. This study applies it to bilateral cleft noses.

Sections of note

• Seven bilateral cleft patients treated with the technique; three comparable patients who did not have the operation served as comparison.
• Follow up photographs were taken at a mean of 18.6 plus or minus 10.8 months.
• Analysis used photogrammetric measurements plus appearance ratings by four blinded observers.
• The columella length to alar width ratio on basal view rose from 0.19 plus or minus 0.05 to 0.28 plus or minus 0.05, P equals 0.001.
• On side view the columella labial angle fell from a median 138 degrees to 123 degrees, P equals 0.04.
• Blinded appearance ratings improved from 1.6 plus or minus 0.8 to 2.4 plus or minus 0.7, P equals 0.004.
• The three untreated comparison patients showed no differences over the same period.
• The technique combines cartilage release, repositioning and an ear composite skin and cartilage graft.

What it means for a patient

• The operation lengthens the short columella typical of a bilateral cleft nose and improves tip support.
• Independent blinded raters, not the surgeons, judged the appearance change.
• Seven treated and three untreated patients is a very small comparison.
• Follow up averaged about 18 months, and these are growing children, so later change is not captured.

Why this paper matters

Bilateral cleft noses have a short columella and weak tip support that persist after infant repair, and timing intermediate surgery before school age is standard practice. This study extends a defined technique to the bilateral case with blinded assessment. Whether the gains hold through facial growth is unknown.

Terms

• Bilateral cleft nose: the nasal deformity accompanying a cleft lip on both sides.
• Intermediate rhinoplasty: nasal surgery performed in childhood between the infant repair and the final adult operation.
• Columella: the strip of tissue between the two nostrils.
• Lower lateral cartilage: the paired cartilage forming the nasal tip.
• Composite chondrocutaneous graft: a graft of skin and cartilage together, here from the ear.
• Photogrammetry: taking measurements from standardized photographs.