Introducing Preservation Rhinoplasty Principles to Cleft Nasal Surgery: Unveiling the Role of Nasal Ligaments in Infant Anatomy

Tanikawa D, Sá Á, Figueroa Á, Chong D, Ishida LC.

What this paper says

In six infants having primary cleft lip and nose repair, releasing and repositioning the Pitanguy ligament relieved tip tension, expanded the skin and helped centre the tip cartilages, suggesting a role for preservation principles in cleft surgery.

Overview

Preservation rhinoplasty stresses ligament integrity, but had not been applied to cleft noses. The authors, who use a modified Tajima (reverse-U) incision, had previously noted kinked cleft-side tip cartilage and abnormal soft-tissue attachments. During primary lip and nose repair on 6 infants (3 unilateral, 3 bilateral cleft lip and palate), they released and repositioned the Pitanguy ligament and reconstructed the intercrural and interdomal ligaments.

Sections of note

6 infants: 3 unilateral, 3 bilateral cleft lip and palate.
Ligament release alleviated tension on the tip and expanded the skin envelope.
Controlled reconstruction of intercrural and interdomal ligaments allowed midline alignment of the lower lateral cartilages.
The authors call for further studies and normative references for cleft nasal anatomy.

What it means for a patient

For families of infants with cleft lip, this is an early report of adapting adult preservation ideas to the first nose repair.
Six patients with no stated follow-up cannot show whether growth or symmetry is improved long term.
It is an idea paper from a group with cleft and preservation expertise (Ishida is a preservation pioneer).

Why this paper matters

It is the first application of ligament-based preservation concepts to cleft rhinoplasty. Limits: six cases, no outcomes, no follow-up stated.

Terms

Cleft lip nasal deformity: the flattened, asymmetric nose that accompanies a cleft lip.
Tajima reverse-U incision: an incision along the nostril rim used to reposition cleft tip cartilage.
Pitanguy ligament: the midline soft-tissue band from bridge skin to tip cartilages.
Intercrural / interdomal ligaments: the fibrous connections between the two tip cartilages.
Lower lateral cartilages: the paired cartilages shaping the tip.

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

From the abstract

“Preservation rhinoplasty emphasizes maintaining ligament integrity for stable and natural surgical outcomes. However, its principles have not yet been applied to primary or secondary cleft nasal deformities. In their experience using a modified Tajima (reverse U) incision for cleft nasal reconstruction, the authors…”

Excerpt; the full abstract is on PubMed.