Septal Extension Graft in Cleft Rhinoplasty: Patients with Secondary Unilateral Cleft Lip Nasal Deformity

Overview

Whether and how to refine the tip in secondary cleft rhinoplasty remains contested. The authors assessed whether the septal extension graft, a cartilage strut anchored to the septum, corrects the tip and nasal deformity and produces a normal profile. They analyzed a consecutive series of 194 patients with unilateral cleft who had secondary open rhinoplasty by a single surgeon between 2013 and 2021, using three dimensional morphometric measurement.

Sections of note

• Design: consecutive case series with matched comparison group. Level of evidence therapeutic IV.
• Comparison group matched for age, sex and ethnicity, drawn from people without clefts.
• Standard procedure: open approach with reverse-U incision, septal extension graft, dorsal augmentation, lip revision and vermilion augmentation.
• Increased after surgery: bridge length, nasal height, tip projection, dorsum angle, columellar angle, columellar-lobule angle, nostril height ratio, nasal surface area and volume.
• Decreased after surgery: alar width, tip and middle deviation, nasal tip angle, labial-columellar angle.
• Against the normal group, results stayed higher for nasal protrusion, tip and middle deviation and dorsum angle, and lower for columellar-lobule angle, nostril height ratio and alar width ratio.

What it means for a patient

• The operation moved multiple measurements in the intended direction, addressing several features of the cleft nose at once.
• The result approached but did not match a matched noncleft group. Residual deviation was still measurable after surgery.
• The comparison against matched normal individuals is a stronger benchmark than before and after measurement alone.
• Limits: single surgeon, no comparison against an alternative technique, and shape measured without breathing or satisfaction data.

Why this paper matters

Cleft rhinoplasty is judged largely on how close the result comes to an unaffected nose, and few studies measure that directly in three dimensions at skeletal maturity. This series does, on a large sample. What it does not settle is whether the septal extension graft outperforms other tip support options in this population.

Terms

• Unilateral cleft lip nasal deformity: the characteristic nasal asymmetry from a one sided cleft.
• Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
• Morphometric analysis: measurement of shape, distances and angles.
• Reverse-U incision: a curved incision inside the nostril used in cleft nasal repair.
• Vermilion: the red part of the lip.