Improved nasal tip projection in the treatment of bilateral cleft nasal deformity

The cleft nose deformity in bilateral cleft lip and palate patients with severely flattened alar cartilages, a short, scarred columella, and thickened skin is a reconstructive challenge. The Wolfe double-arch tip rhinoplasty technique was compared with a cartilage release and tip grafting technique to determine the optimal modality for tip projection and columella lengthening. Patients with significant bilateral cleft nasal deformities and previous bilateral cleft lip repairs were divided into two groups (n = 22). Group 1 (double-arch) patients underwent an open rhinoplasty using conchal cartilage grafts to create a columellar strut and new lower lateral arches placed over the existing arches (n = 12). In group 2 (release and tip graft), the lower lateral cartilages were released, and nasal tip grafting was performed (n = 10). Preoperative and 6-month postoperative measurements, including (1) columellar length, (2) alar base-nasal tip-columellar base (ATC) angle, and (3) lateral tip projection, were compared. The lateral tip projection is the perpendicular distance between the nasal tip and a line created from the connection of points at the nasion to the subnasale. In group 1 (double arch), the mean columella length increased 47.2%, whereas in group 2 (release and tip graft), it only increased 14.1%. The ATC angle had a mean decrease or narrowing of 26.7 degrees in group 1, compared with a 12.5 degrees decrease in group 2. Lateral tip projection improvement was greater in group 1 (52.2% increase) compared with group 2 (19.9% increase). The authors' data showed that for the difficult bilateral cleft nasal deformity with significant tip flattening, the double-arch tip rhinoplasty provides improved nasal tip projection.