Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty

Çerçi Özkan A, Bilgili AM, Kozanoğlu E.

PubMed 36323963 Publisher (DOI)Free full text (PMC)

What this paper says

In 42 cleft rhinoplasty patients needing nostril length equalization, the ratio between cleft and non cleft nostril length improved from 0.714 before surgery to 0.971 at one year, where 1.0 means equal.

Overview

Bone and cartilage deformities in cleft rhinoplasty can be corrected by several techniques, but the front to back lengths of the two nostrils may remain unequal. The authors designed a technique to balance those lengths and the shape of the nostril apex. The non cleft nostril was shortened by reducing the inner tip cartilage, and the cleft nostril lengthened using a three part mini flap reconstruction at the soft triangle.

Sections of note

Case series; 78 one sided cleft rhinoplasties were performed between January 2019 and May 2022, of which 42 needed nostril length equalization; level of evidence IV.
Twenty nine of those patients were female and 13 male; 33 were primary and 9 secondary cleft rhinoplasties.
Mean age was 28 years, range 22 to 39; mean follow up 25 months, range 6 to 40.
The nostril balancing ratio was calculated by dividing cleft side length by non cleft side length on base view photographs.
A ratio closer to 1.0 indicates more equal nostril lengths.
Mean ratios were 0.714 before surgery, range 0.621 to 0.813.
The mean was 0.743 during surgery, range 0.721 to 0.752.
The mean was 0.971 after surgery, range 0.943 to 0.976.

What it means for a patient

Cleft noses commonly have one nostril shorter front to back than the other even after the main deformity is corrected.
The technique shortens one side and lengthens the other rather than treating only the cleft side.
The measured ratio moved close to equal and held at a mean 25 months.
Forty two patients from one surgeon with photographic measurement and no comparison group is limited evidence.

Why this paper matters

Nostril asymmetry is one of the most visible residual features of a repaired cleft nose and is measured inconsistently. This paper defines a ratio and reports it before, during and after surgery. Whether patients perceive the change was not assessed.

Terms

Anteroposterior diameter: the front to back length of the nostril.
Cleft side: the side of the nose affected by the cleft.
Medial crural reduction: shortening the inner leg of the tip cartilage.
Soft triangle: the soft tissue area at the top of the nostril rim.
Mini flap: a small piece of tissue moved to reconstruct a defect.
Base view: the view of the nose looking up from below.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes.

Materials And Methods: Balance between AP nostril diameters was accomplished by reduction of the AP diameter of the nostril at the non-cleft side by medial crural reduction and augmentation of the AP diameter of the nostril at the cleft side by three-parted mini-flap reconstruction at the soft triangle. The cleft-side AP diameter length was divided by the non-cleft-side AP diameter length of the same preoperative, per-operative and 1-year postoperative base view photographs of each patient, and "nostril balancing ratio" was obtained. The more this ratio was near to "one," the more the AP nostril diameters were equal.

Results: Seventy-eight unilateral-cleft rhinoplasty were performed between January/2019 and May/2022. Forty-two of them required nostril AP diameter equalization. Twenty-nine patients were female, thirteen were male. Thirty-three of them were operated for a primary cleft rhinoplasty. Nine of them for secondary cleft rhinoplasty. Mean age was 28 years (22-39 years). Mean follow-up was 25 months (6-40 months). The preoperative, per-operative and postoperative mean "nostril balancing ratios" were 0.714 (0.621-0.813), 0.743 (0.721-0.752) and 0.971 (0.943-0.976), respectively.

Conclusion: Balancing AP diameter symmetry with MCO at the non-cleft side and three-parted mini skin flap reconstruction at the cleft side may provide the satisfactory results. Three mini-flaps at the soft triangle may remold the nostril apex in an oval shape, which may result in a better shape symmetry.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).