Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair

Overview

The nose after a one sided cleft lip repair carries several problems at once: a horizontally set nostril wing, a wide nostril on the cleft side, a defect at the nasal base and a short deviated columella. The authors addressed all of these using rib cartilage alone, prepared in different forms, at Cho Ray Hospital in Vietnam.

Sections of note

• Design: case series of 39 patients with prior unilateral cleft lip surgery. Average age 25.13 years.
• Rib cartilage was partially crushed then finely cut to shape the bridge and raise the nasal base on the cleft side, and also used for shield, cap and alar batten grafts. Sliced cartilage was used for septal extension grafts.
• Assessment used photographic measurements plus the Rhinoplasty Outcome Evaluation and FACE-Q questionnaires. All postoperative measurements improved significantly.
• Total Rhinoplasty Outcome Evaluation score was three times higher after surgery, p less than 0.001; total FACE-Q score was 2.26 times higher, p less than 0.001.
• No significant complications occurred during or after surgery.

What it means for a patient

• Rib supplies enough material to address every part of the cleft nose in one operation, from the bridge to the nostril base.
• Preparing the same cartilage in different forms, crushed for soft contour and sliced for support, avoids needing a second donor site.
• Satisfaction scores roughly tripled, though scores starting low have more room to rise.
• Limits: 39 patients, single centre, no comparison group, no stated follow up length, and rib harvest requires a chest incision the abstract does not discuss.

Why this paper matters

Cleft rhinoplasty typically draws on several graft sources, each adding a donor site. Showing that rib alone can supply the whole reconstruction simplifies the operation, which matters most in settings where multiple procedures are hard to arrange. Durability of the result, and comparison with mixed graft approaches, is unaddressed.

Terms

• Unilateral cleft lip: a birth difference where the lip did not join on one side.
• Costal cartilage: cartilage from the ribs, harvested for use as a graft.
• Crushed cartilage: cartilage flattened so it can be laid as a soft smoothing layer.
• Shield and cap grafts: cartilage pieces placed on the tip to shape and project it.
• Alar batten graft: a cartilage strip placed under the nasal sidewall to keep it from collapsing.
• Columella: the strip of tissue between the nostrils.