A Novel Approach to Intermediate Cleft Rhinoplasty Utilizing a Pedicled Fibrofatty Flap

Lasky S, Moshal T, Jolibois M, Roohani I, Jimenez C, Manasyan A, Naidu P, Nagengast ES, Magee WP 3rd.

PubMed 39911533 Publisher (DOI)Free full text (PMC)

What this paper says

In 43 children with cleft lip operated at a mean age of 5.5 years, an open rhinoplasty using a dorsal fibrofatty flap on its own blood supply improved nasal form and deviation on the Asher-McDade index with no complications and one revision (2.3%).

Overview

Children with cleft nasal deformity can face teasing well before facial growth is complete. The senior author performs an early open rhinoplasty using a pedicled dorsal fibrofatty flap. The Los Angeles team retrospectively reviewed unilateral and bilateral cleft patients under 10 treated from 2008 to 2023, with two reviewers grading photographs on the Asher-McDade Aesthetic Index.

Sections of note

43 patients; mean age 5.5 (SD 1.1) years.
Significant improvement in nasal form (P < 0.001) and nasal deviation (P < 0.001).
No intraoperative or postoperative complications.
One patient (2.3%) had revision surgery.
Long-term follow-up is planned to establish the final revision rate.

What it means for a patient

For a child with marked cleft nasal asymmetry and psychosocial distress, an operation around school entry can improve appearance safely in this series.
The final revision rate after facial growth is not yet known.
Results were judged on photographs by reviewers, not by patient-reported measures.

Why this paper matters

It supports earlier intervention for children with significant cleft nasal asymmetry, using a tissue flap rather than a graft. Limits: retrospective, single surgeon, short follow-up relative to growth, photographic grading.

Terms

Intermediate cleft rhinoplasty: childhood nasal surgery between infant repair and the definitive teenage operation.
Pedicled flap: tissue moved while still attached to its blood supply.
Fibrofatty flap: a flap of the fibrous fatty tissue lying over the nasal bridge.
Asher-McDade Aesthetic Index: a standardised photographic scoring system for cleft nose and lip appearance.

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

Abstract

Patients with cleft lip ± palate may experience psychosocial issues related to their secondary cleft nasal deformities. These concerns can be addressed earlier instead of being required to wait until skeletal maturity. A novel early rhinoplasty intervention utilizing a dorsal fibrofatty pedicled flap is performed by the senior author to address nasal aesthetics in patients with secondary nasal deformities. This study aimed to describe this novel intermediate rhinoplasty technique and to evaluate improvement of nasal aesthetics. A retrospective review of patients with unilateral and bilateral cleft lip who underwent open rhinoplasty by a single surgeon at less than 10 years old from 2008 to 2023 was conducted. To evaluate aesthetic improvement, preoperative and postoperative photographs of patients were graded by 2 reviewers utilizing the Asher-McDade Aesthetic Index. Paired t tests compared preoperative and postoperative Asher-McDade Aesthetic Index nasal form and nasal deviation scores. A total of 43 patients underwent early rhinoplasty utilizing this technique at an average age of 5.5 ± 1.1 years. Compared with preoperative photographs, postoperative photographs of patients demonstrated a significant improvement in nasal form (P < 0.001) and nasal deviation (P < 0.001). No intraoperative or postoperative complications were reported. Only 1 (2.3%) patient underwent revisional surgery. Long-term follow-up will assess the finalized revision rate. This technique is a safe and valuable tool in patients who benefit from earlier treatment of secondary cleft nasal deformities due to significant asymmetry and psychosocial concerns.

Abstract as indexed by PubMed; the article is open access (PubMed Central).