Three-Dimensional Analysis of Definitive Secondary Unilateral Cleft Rhinoplasty Using Cartilage Graft

Abstract

Objective Three-dimensional assessment of nasal morphology in patients with unilateral cleft lip nose treated by cartilage graft augmentation. Design Retrospective study. Patients and Intervention Thirteen patients with unilateral cleft lip nose underwent definitive secondary rhinoplasty and postsurgical changes were examined using a three-dimensional (3D) laser scan. Main Outcome Measure Nasal dorsum length, nasal tip, alar width, and alar base width in frontal view; nasion depth, nasal tip projection, nasal dorsal angle, and nasal tip angle in lateral view; nostril width, nostril height, and nasal tip height in basal view were measured at preoperative (T1: within 6 months), short follow-up (T2: 2-10 weeks), and long follow-up (T3: 9-14 months). Results A significant change in alar width, alar base width, nostril width, and nostril height at the cleft side, nasal dorsum length, nasion depth, nasal tip projection, and nasal tip height was observed from T1 to T3 follow-up after rhinoplasty ( P < .05), whereas the nostril height at the noncleft side was also significantly increased at T2 follow-up but the mean change in height relapsed at T3 follow-up. Alar width, alar base width, and nostril width at the noncleft side, and nasal tip angle did not change significantly after surgery at any follow-up period. Conclusions 3D imaging evaluation after secondary cleft rhinoplasty demonstrated improved functional and aesthetic outcomes using a septal or conchal graft.

Augmentation Rhinoplasty in Cleft Lip Nasal Deformity Using Alloplastic Material and Autologous Cartilage

“…14 The lowest relapse rates were seen in nostril width (26.23%) and height (28.57%) corrections. 14 Late relapse in these cases may be from graft warpage or resorption which is less of a concern with alloplasts. Implant or graft displacement generally occurs earlier on in the recovery course.…”

“…In their series, the highest relapse rates were found to occur in nasal tip height (50.68%), nasal tip projection (45.45%), and alar base width (42.74%) 14. The lowest relapse rates were seen in nostril width (26.23%) and height (28.57%) corrections 14. Late relapse in these cases may be from graft warpage or resorption which is less of a concern with alloplasts.…”

“…Hantawornchaikit et al14 performed their cleft rhinoplasties using septal and conchal cartilage to prepare dorsal diced cartilage grafts, columellar struts, tip shield grafts, and alar onlay grafts as needed. In their series, the highest relapse rates were found to occur in nasal tip height (50.68%), nasal tip projection (45.45%), and alar base width (42.74%) 14. The lowest relapse rates were seen in nostril width (26.23%) and height (28.57%) corrections 14.…”

Donor site morbidities of concha cartilage harvesting using a retroauricular approach for cleft rhinoplasty: retrospective study

“…Therefore, concha cartilage can be used when shaving the nasal cartilage. Some grafts are stable enough to support the infrastructure of the nasal cartilage and produce good results 21 . Importantly, the harvesting technique can be performed by less experienced surgeons, and intraoperative complications are not serious.…”

Rhinoplasty in Patients with Cleft Lip Nasal Deformity: Correcting the Alar Base

“…Other studies using three-dimensional imaging looking at overall changes to multiple aspects of rhinoplasty, not just the alar base, found improvement with alar positioning with suture techniques and conchal cartilage onlay grafts though with less significant, long-term changes. 18 At out cleft center, we address the alar base for CLND with a series of interventions from infancy to adulthood. We will illustrate these in the following case.…”