Adjuncts to Cleft Rhinoplasty and Beyond the Core Procedure

Cleft lip nasal anomalies result in distinct characteristics affecting various aspects of the nose including rotation and projection, columella and septal deviation, and asymmetry of the rim and alar base. This study aims to evaluate the type and frequency of surgical adjuncts performed during a series of consecutive cleft septorhinoplasty performed over a 10-year period. Patient demographics, procedures performed, and details of supplementary procedures, including lip revision, lip augmentation, composite grafts and alar base procedures were analysed. 109 patient records were included (67 females, 42 males, aged 7-53) who underwent cleft septorhinoplasty between June 2013 and March 2024. Simultaneously, 30% (n = 33) had alar base adjustments (Weir excisions, sill excisions, combined Weir and sill excisions, alar base transpositions). 16% (n = 17) underwent alar base augmentation (morselised cartilage in 7 cases, paranasal implants in 10 cases). 8 composite conchal grafts were used to lower asymmetrical nostril rims. 46% of patients (n = 50) had lip scar revision surgery; 28% (n = 20) had a dermal graft to the upper lip. 5 patients had lip augmentation using free fat grafting and 6 with a PermaLip implant. Overall, 29% (n = 32) of cases had some form of lip revision surgery performed simultaneously with their rhinoplasty. The incorporation of surgical adjuncts in cleft septorhinoplasty improves patient profile and symmetry. The decision to use them is based on individual assessment but can combine to improve final aesthetic outcomes with the potential benefit of avoiding separate lip surgeries.