Secondary Bilateral Cleft Rhinoplasty: Achieving an Aesthetic Result

Overview

Secondary rhinoplasty in bilateral cleft lip remains difficult and lacks an agreed method. The authors report a consecutive series of skeletally mature patients treated between 2013 and 2021 with a bilateral reverse-U flap and a septal extension graft. Records of all 92 were reviewed, and 32 underwent three dimensional measurement plus panel assessment against a matched normal control group.

Sections of note

• Design: consecutive case series, single surgeon, with a matched normal control group.
• 92 patients reviewed for clinical course; 32 assessed by three dimensional anthropometry and panel rating.
• Control group matched for age, sex and ethnicity.
• Significantly improved: columellar height, nasal bridge length, tip projection and dorsum angle, plus tip angle, dome height and panel assessment for tip definition, and alar width and nostril type for transversely oriented nostrils.
• Complication rate: 4 percent.
• Not significantly improved: upper lip deficiency, by the upper lip angle and labial-columellar angle.

What it means for a patient

• Bilateral cleft noses typically have a short columella, a flat tip and horizontally set nostrils, and this technique improved all three measurably.
• What did not improve was the upper lip, which is a separate structure the nasal operation does not address.
• Comparing against age, sex and ethnicity matched controls is a demanding benchmark and stronger than before and after measurement alone.
• Limits: single surgeon, no comparison against an alternative technique, and only 32 of 92 patients underwent the detailed measurement.

Why this paper matters

Bilateral cleft nasal deformity is more severe and less studied than the one sided form, and few series report objective three dimensional outcomes at skeletal maturity. This one does, on a large sample with a low complication rate. It does not establish that this technique outperforms others, and it identifies the lip as an unsolved part of the problem.

Terms

• Bilateral cleft lip: a birth difference where the lip did not join on both sides.
• Columella: the strip of tissue between the nostrils.
• Reverse-U flap: a curved flap raised inside the nostril to lengthen the columella.
• Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
• Dome height: the height of the peak of the tip cartilage.
• Anthropometric analysis: measurement of physical dimensions and angles of the body.