Component Restoration in the Unilateral Intermediate Cleft Lip Rhinoplasty: Technique and Outcomes

Abstract Background The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psycho- social development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component. Methods This was a prospective comparative study in which the technique results were compared to age-matched unilateral cleft lip and palate control patients (n = 20). A separate group of unilateral cleft lip and palate patients who did not undergo intermediate cleft tip rhinoplasty were reviewed as control patients. Photographs of control patients were age-matched to each time point in the intermediate cleft tip rhinoplasty group. Technique of rhinoplasty was through an open approach. It was depending on restoration of the three main nasal cleft components; cartilage malposition, cartilage weakness and vestibular lining deficit. The authors here didn’t use cutaneous graft routinely to compensate the vestibular lining deficit. Instead, fine and complete dissection of the cleft side lower lateral cartilage from its vestibular lining before any cartilage repositioning. Standardized preoperative and postoperative basal view photographs were assessed at four time points: preoperatively (time 0), immediately postoperative (time 1), 3- 6 months (time 2), and more than 1 year postoperatively if available (time 3). Assessments of control and intermediate cleft tip rhinoplasty patients was carried out using four photo- morphometric relationships: Alar symmetry Nasal tip protrusion to alar base width, Cleft nostril dimensions, and Non-cleft nostril dimensions. Results Preoperative (time 0) baseline comparison between the study and the control groups showed significant differences regarding the nostril dimensions at the cleft side (P value 0.027) and alar symmetry (P value 0.000) denoting more severe deformity in the study group compared to the control group. At time 1, the study showed significant improvement regarding the alar symmetry (P value 0.000), and nasal tip protrusion (P value 0.004), while the changes regarding nostril dimension at the cleft side were non-significant (P value 0.057). At time 2, the study added significant improvement regarding the nostril dimensions at the cleft side (P value 0.049) that may reflect the importance of follow-up and using the nostril silicon retainer. At all times no significant changes regarding the nostril measures at non-cleft side were noticed. Conclusion The modified component restoration technique for the unilateral intermediate cleft lip rhinoplasty improves nasal relationships regarding alar symmetry, nostril dimensions at the cleft side, and nasal tip protrusion.