Double Reinforcing Strategy with Perpendicular Plate of Ethmoid in Asian Secondary Unilateral Cleft Rhinoplasty: A Finite Element Analysis

Zhang S, Li Z, Zhang C, Deng R, Wang G, Zhen Y, Zhou J, An Y.

PubMed 38839614 Publisher (DOI)Free full text (PMC)

What this paper says

Computer simulation of cleft nose repairs found that reinforcing the septal support strut with ethmoid bone, plus firm anchoring of the septum, substantially reduced predicted deformation under load.

Overview

Cleft noses corrected with a septal extension graft often drift back toward deviation and asymmetry, particularly in Asian patients. The authors used finite element analysis, a computer method predicting how a structure deforms under force, to compare correction and reinforcement strategies under simulated loads.

Sections of note

Design: finite element modelling study. Level of evidence IV. Maximum deformation was the measure of stability.
Loads applied: 0.01 newtons at the tip for soft tissue pressure, plus two 0.5 newton loads at the front and back of the septal extension graft.
Deformation ranked from least to most: cleft deformity with septum correction, normal cartilage, uncorrected cleft deformity, and cleft deformity with lower lateral cartilage correction alone.
Reinforcing the L-strut with a graft from the perpendicular plate of the ethmoid significantly reduced maximum deformation, and firm septal fixation enhanced that further.
The authors state the strategy was effective in both the simulation and clinical observation, though no clinical data appear in the abstract.

What it means for a patient

Relapse after cleft nose surgery is a mechanical problem: the corrected structure is pushed back by the tissue around it.
The modelling suggests correcting the septum matters more than correcting the tip cartilage alone, since tip correction by itself ranked worst for stability.
Bone from the ethmoid, which sits behind the septum, is stiffer than cartilage and is used here as a splint.
Limits: this is a computer simulation, not a patient study. It predicts deformation under idealized loads and reports no patient outcomes or follow up.

Why this paper matters

Relapse is the central failure of secondary cleft rhinoplasty, and choosing reinforcement has been guided by experience rather than mechanics. Modelling makes the structural argument explicit and testable. Whether the predicted stability translates into less relapse in patients has not been demonstrated here.

Terms

Finite element analysis: a computer method predicting how a structure deforms under applied force.
Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
L-strut: the L shaped strip of septal cartilage left to support the nose after septoplasty.
Perpendicular plate of the ethmoid: the thin bone forming the upper rear part of the septum.
Relapse: the return of a deformity after it has been corrected.

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

Abstract

Background: Deviation and asymmetry relapse after secondary unilateral cleft rhinoplasty with septal extension graft is a common yet serious problem especially among Asian patients. Therefore, finding an effective approach to reduce deformity relapse remains a great challenge to plastic surgeons.

Methods: In this study, authors established finite element models to simulate different nasal cartilage-corrected options and different reinforcing strategies in secondary unilateral cleft rhinoplasty. A load of 0.01N was given to the nasal tip to simulate the soft tissue pressure, while two loads of 0.5N were separately given to the anterior and posterior part of the septal extension graft to simulate the rhinoplasty condition. Maximum deformations were evaluated to make stability judgments.

Results: The maximum deformation of different cartilage correction models in ascending order was: UCL deformity with septum correction, normal nasal cartilage, UCL nasal deformity, and UCL nasal deformity with lower lateral cartilage correction. When applied L-strut reinforcement graft was harvested from the perpendicular plate of the ethmoid bone, the maximum deformation of the models decreased significantly, and strong fixation of the septum could further enhance this decreasing effect.

Conclusions: Correcting the septum and lower lateral cartilage together could improve the structural stability and symmetry in secondary unilateral cleft rhinoplasty. To keep the corrected septum stable and thus reduce deformity relapse, reinforcing the L-strut with perpendicular plate of ethmoid graft while strongly anchoring the septal cartilage to the anterior nasal spine was proved to be effective in both finite element analysis and clinical observation.

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).