Nasal Morphological Changes after Facial Maturation in Patients with Unilateral Cleft Lip Following Primary Overcorrected Rhinoplasty

Overview

Chang Gung's craniofacial centre uses the Tajima overcorrection technique at the primary lip repair and had noticed a small, stable asymmetry afterwards. This retrospective study followed 146 non-syndromic patients operated in 2002-2003 with photographs at 1, 5, 10, 15 and 18 years, measuring nostril height, nostril base height, nostril width, nasal width and columella angle.

Sections of note

• 146 patients; five photographic time points from age 1 to 18.
• Nostril asymmetry improved over time in both complete and incomplete clefts.
• Nostril height, nostril width, nasal width and columella angle changed significantly with time (P < 0.01).
• Nostril base height remained stable throughout growth.
• The authors conclude that achieving adequate cleft-side nasal height at the primary operation is crucial.

What it means for a patient

• Some asymmetry seen after an infant's cleft nose repair improves on its own as the face grows.
• Nostril base height does not self-correct, so it must be set right at the first operation.
• The data can guide when a secondary (touch-up) rhinoplasty is worth doing.

Why this paper matters

Eighteen-year longitudinal data on cleft nasal growth are rare and directly inform timing decisions. Limits: retrospective, single centre, single technique, photographic measurement.

Terms

• Unilateral cleft lip: a cleft on one side of the upper lip, usually with nasal distortion on that side.
• Primary rhinoplasty (cleft): nasal correction done with the infant lip repair.
• Tajima technique: a reverse-U rim incision that lifts and overcorrects the cleft-side tip cartilage.
• Overcorrection: deliberately over-lifting at surgery anticipating some relapse.
• Columella angle: the tilt of the columella from vertical.