Surgical procedures for nasal deformity in patients with cleft lip and palate

External nasal deformity in patients with cleft lip and palate causes both functional and aesthetic problems. Corrective rhinoplasty using a reverse U-shaped incision and suturing of the alar cartilage is not always successful. Therefore, we compared the use of a newer septal extension graft technique with the conventional suture technique to determine an effective surgical method for improving nasal tip morphology.

We compared the outcomes of the conventional reverse U-shaped incision technique with the septal extension graft in 12 patients undergoing secondary cleft rhinoplasty (6 in each group). Ten plastic surgeons evaluated 6-month postoperative photographs using six criteria: nasal tip shape (frontal, lateral, and basal views), left-right asymmetry (frontal and basal views), and overall improvement. Each item was rated on a 4-point scale (1=poor, 4=excellent). Mann-Whitney U tests were used to assess statistical significance.

The septal extension graft group showed significantly better nasal tip morphology in the frontal and basal views (P<0.001) and in the lateral view (P=0.007). However, there were no significant differences in symmetry improvement between the two techniques for the front (P=0.685) and bottom (P=0.602) views.

Corrective rhinoplasty using a septal extension graft can significantly improve nasal tip morphology in cleft lip cases compared with the reverse U-shaped incision and alar cartilage suturing technique. However, decreased mobility of the nasal tip was noted. Further improvement is needed in terms of patient-reported satisfaction and postoperative stability.