Technique in Cleft Rhinoplasty: The Foundation Graft

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Rhinology

Background:

• Secondary cleft rhinoplasty presents significant surgical challenges.
• Piriform rim skeletal projection deficits on the cleft side are key pathological contributors.
• Existing techniques may not fully address the complex deformities in secondary cleft rhinoplasty.

Purpose of the Study:

• To describe a novel surgical technique for secondary cleft rhinoplasty.
• To address piriform rim deficiency and improve cleft-sided nasal tip projection.
• To correct associated nasal deformities like vestibular stenosis.

Main Methods:

• A foundation graft is used to augment the piriform crest on the cleft side.
• The graft is secured after releasing soft tissue attachments to the alar base.
• Articulation with an alar strut graft provides nasal tip projection; vestibular advancement flaps and cartilage grafts address other deformities.

Main Results:

• The described technique effectively augments the piriform crest and enhances nasal tip projection.
• Correction of vestibular stenosis and maxillary soft tissue volume was achieved.
• A retrospective series of five cases demonstrated positive subjective and objective outcomes.

Conclusions:

• The described surgical approach offers a viable solution for secondary cleft rhinoplasty.
• Augmentation of the piriform rim and nasal tip projection are crucial for functional and aesthetic improvement.
• This technique shows promise in addressing the complex anatomical challenges of cleft-sided nasal deformities.