Impact of Nasal Stents on Three-Dimensional Morphologic Outcomes Following Primary Cleft Rhinoplasty in Unilateral Cleft Lip

BACKGROUND: Objective assessment of nasal stents following primary cleft rhinoplasty is limited. Using three-dimensional (3D) photogrammetry, this 10-year study quantifies how postoperative nasal stents affect nasolabial morphology after unilateral cleft rhinoplasty. METHODS: A retrospective review included patients with unilateral cleft lip (uCL) repair from 2013 to 2023. Patient age, surgical technique, nasal stent use, and 1-year postoperative 3D photos were collected. A total of 29 facial landmarks were manually annotated to obtain 15 facial measurements. Fisher's exact test and Mann-Whitney U tests were used for comparisons. RESULTS: A total of 26 uCL patients were included, and 9 received postoperative nasal stents for an average of 3.83 months. Stented patients had more severe clefts (100% complete versus 41.2%, P=0.004) and higher CSI scores (3.22 versus 1.85, P=0.004) at baseline compared with nonstented patients. At 9 to 15 months, stented patients showed better nasal projection and alar base support, with a larger subnasale-subalare-pronasale angle on the cleft side (58.2° versus 50.0°, P=0.004), greater subalare-subnasale distance (11.90 versus 10.02 mm, P=0.020), and higher cleft/noncleft subnasale-subalare-pronasale angle ratio (1.13 versus 0.99, P=0.025) compared with those without stents. Vertical nasal symmetry and other facial measurements did not differ. CONCLUSION: Postoperative nasal stents significantly improve nasal tip projection and alar base support following primary cleft rhinoplasty, with stented patients showing superior anteroposterior symmetry despite having more severe baseline cleft severity. They can be a useful adjunct to maintain surgical correction and counteract early soft-tissue relapse, especially in complete and high-severity clefts.