Long-Term Surgical Outcomes of Intermediate Cleft Rhinoplasty

Ng JJ, Cheung L, Massenburg BB, Cho DY, Wu M, Romeo DJ, Swanson JW, Jackson OA, Low DW, Taylor JA.

What this paper says

In 372 intermediate cleft rhinoplasties over 18 years, using an iliac crest cartilage graft, a V-Y chondromucosal flap in unilateral clefts, or a columellar strut in bilateral clefts each predicted fewer later rhinoplasties, and 55% of patients followed past age 18 needed no further surgery.

Overview

Operating on the cleft nose during the mixed-dentition years is debated. The Philadelphia authors reviewed 342 patients who had 372 intermediate rhinoplasties from 2006 to 2023, recording graft type and technique, with complications and need for subsequent rhinoplasty as the outcomes, adjusted for age, sex, race, syndrome status, cleft severity, stenting and surgeon.

Sections of note

Graft use: none 150 (40.3%), iliac crest cartilage 165 (44.4%), ear cartilage 36 (9.7%), resorbable plate 19 (5.1%), nasal cartilage 3 (0.8%).
Iliac crest graft predicted fewer subsequent rhinoplasties independently (beta -0.234; P = 0.012).
V-Y chondromucosal flap in unilateral clefts (beta -0.401; P = 0.002) and columellar strut in bilateral clefts (beta -0.450; P = 0.028) predicted fewer subsequent operations.
Iliac crest use rose over time (r = 0.806; P < 0.001).
55.0% of the 60 patients followed beyond 18 needed no further rhinoplasty. Level of Evidence III.

What it means for a patient

A childhood cleft rhinoplasty that adds structural support (a graft) reduced the chance of needing another operation later in this series.
Just over half of those followed into adulthood needed nothing more.
The authors say the burden and patient-reported benefit of the intermediate operation still need study.

Why this paper matters

It is a large, long-running series that identifies specific techniques linked to durable results in childhood cleft rhinoplasty. Limits: retrospective, single centre, revision as the sole outcome.

Terms

Intermediate cleft rhinoplasty: nasal surgery during childhood, between the infant repair and the definitive teenage operation.
Mixed dentition: the years when baby and adult teeth are both present, roughly 6 to 12.
Iliac crest cartilage: cartilage from the hip bone rim, used as a graft in children.
Chondromucosal V-Y flap: an internal flap of cartilage and lining advanced to lengthen the cleft-side nostril.
Columellar strut: a cartilage post supporting the tip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“The risk-to-benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes the authors' 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion. Methods: The authors performed a retrospective cohort study of…”

Excerpt; the full abstract is on PubMed.