Secondary cleft lip rhinoplasty. Our experience of two decades

Patients who underwent cleft lip surgery in childhood may develop nasal malformation later in life. Various procedures have been described to correct these malformations. This study aims to describe our surgical approach and assess the morphometric outcomes of secondary cleft-lip rhinoplasty performed at the plastic surgery department in Marseille between 2002 and 2022. We conducted an analysis of surgical procedures and nasal morphometrics results by measuring pre- and postoperative images. Both surgical procedures and nasal morphometric analyses have been performed. This study included 43 patients, with 70% presenting unilateral cleft lip and 30% bilateral cleft-lip. An open approach was performed in 90% of cases. Regarding the surgical steps, a tip rhinoplasty, tip reinforcement, and crus lateral reinforcement by cartilage grafting was performed in 98%, 96%, and 32% of cases. A septal extension graft, a columellar strut, and a "tongue in groove" technique were performed in 54%, 33%, and 4% of cases, respectively, to reinforce the tip. Cartilage harvested from the nasal septum, ribs, and ear was utilized in 44%, 23%, and 20% of cases. An osteotomy, septoplasty associated with a spreader-flap, alar base reduction, and alar to triangular cartilage fixation were performed in 67%, 79%, 16%, and 16% of cases. All pre- and postoperative nasal morphometrics measurements have demonstrated a statistical significant improvement in nasal morphology following surgery. An open approach rhinoplasty, facilitating alar cartilage dissection and reinforcement by septal, rib, or ear cartilage is crucial to preserve postoperative outcomes. Our technique enables favorable mid-term results on secondary cleft-lip rhinoplasty.