Comparison of suture and graft techniques in secondary unilateral cleft rhinoplasty

Every surgeon should master several techniques to modify the nasal tip. For secondary rhinoplasty, various techniques have been described. A modified technique of using the cephalic trim portion of lower lateral cartilage as onlay tip graft is also described. The objective of this single-blind randomized controlled trial was to compare the outcome of suture-only techniques and grafts-plus-suture techniques in terms of postoperative tip projection made measurable by the patient as excellent, good, or poor. Sixty patients with cleft nasal tip deformity who gave informed consent were included and randomly assigned to either technique. Patients requiring osteotomies and previously operated on for cleft rhinoplasty were excluded. Postoperative tip projection was assessed by the patient 6 months postoperatively. Mean age was 28.5 ± 2.1 years in suture technique (group A) and 29.1 ± 1.9 in suture-plus-graft technique (group B). There were 20 males (66.7%) and 10 females (33.3%) in group A and 22 males (73.3%) and 8 females (26.5%) in group B. Nasal deformity was moderate in 66.7% of cases in group A and 60.0% of cases in group B, whereas nasal deformity was severe in 33.3% of cases in group A and 40% of cases in group B. Postoperative tip projection was excellent in 7 patients (23.3%) in group A and 22 patients (73.3%) in group B, and good in 4 patients (13.3%) in group A and 5 patients (16.7%) in group B, whereas poor results were observed in 19 patients (63.4%) in group A and 3 patients (10.0%) in group B (P = 0.001). Graft-plus-suture technique is an effective method for improving the tip projection.