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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

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Secondary Cleft Rhinoplasty Using Circumferential Alar Rim Cartilage Graft: Surgical Technique and Morphometric

S Moltaji¹, A Wang¹, F Cardemil²

¹Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, ON, Canada.

The Journal of Craniofacial Surgery

|March 3, 2025

Summary

This summary is machine-generated.

Secondary cleft rhinoplasty is difficult. A circumferential alar rim graft (CARG) technique significantly improved nasal symmetry and tip projection in patients with cleft lip and palate.

Keywords:

Alar rim cartilage graft cleft lip and palate cleft rhinoplasty nasal symmetry

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Published on: November 4, 2025

Area of Science:

Plastic Surgery
Craniofacial Surgery
Rhinoplasty

Background:

Secondary cleft rhinoplasty presents significant challenges in achieving nasal symmetry.
The circumferential alar rim graft (CARG) technique is introduced to address these challenges by repositioning the ala.

Purpose of the Study:

To evaluate the efficacy of the CARG technique in improving nasal symmetry in secondary cleft rhinoplasty.
To assess changes in nostril dimensions and tip projection post-CARG surgery.

Main Methods:

A cohort of adult patients with unilateral cleft lip and palate undergoing secondary cleft rhinoplasty between 2013-2022 were analyzed.
Morphometric analysis of standardized photographs compared preoperative and postoperative nostril height, width, area, and tip projection.
Statistical analysis using the Wilcoxon signed-rank test identified significant differences.

Main Results:

Nostril height symmetry improved by 10% (P <0.001), width by 22% (P=0.012), and area by 21% (P=0.008).
Tip projection increased significantly by 10% (P=0.029).
Five CARG-related complications were reported, including graft detachments and fracture.

Conclusions:

The CARG technique demonstrates significant improvement in nasal symmetry, particularly in nostril height and area.
This technique offers a viable solution for correcting asymmetry in secondary cleft rhinoplasty.