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Photomorphometric Analysis-based Surgical Outcomes in Intermediate Cleft Rhinoplasties: An 18-Year Experience.

Liana Cheung1, Allison C Hu, Jinggang Ng

  • 1Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

The Journal of Craniofacial Surgery
|December 24, 2025
PubMed
Summary
This summary is machine-generated.

Intermediate cleft rhinoplasty (ICR) significantly improves nasal symmetry and projection in children with cleft lip and/or palate (CL/P). Iliac crest cartilage grafts provide durable results for unilateral clefts, reducing the need for revision surgeries.

Keywords:
Bone graftingcleft lip and palaterhinoplasty

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Area of Science:

  • Plastic Surgery
  • Craniofacial Surgery
  • Pediatric Surgery

Background:

  • Intermediate cleft rhinoplasty (ICR) addresses complex nasal deformities in children with cleft lip and/or palate (CL/P).
  • Optimal surgical planning and outcome assessment for ICR remain underdefined.
  • Quantitative photomorphometric analysis (PMM) can objectively evaluate ICR outcomes.

Purpose of the Study:

  • To evaluate surgical decision-making and postoperative outcomes in ICR using PMM.
  • To analyze the impact of graft selection, positioning, and suture techniques on nasal symmetry and projection.
  • To compare outcomes in unilateral versus bilateral cleft nasal deformities.

Main Methods:

  • Retrospective review of 317 nonsyndromic children undergoing ICR (2006-2023).
  • Analysis of operative data including graft type, positioning, and sutures.
  • Quantitative PMM using standardized photographs to measure nasal symmetry and projection.

Main Results:

  • 128 patients had adequate PMM data; significant improvements in symmetry and projection were observed post-ICR (P<0.01).
  • Iliac cartilage grafts and cleft-side alar batten grafts showed superior results in unilateral clefts.
  • Interdomal sutures improved projection; modified Potter V-Y flap improved symmetry/projection in bilateral clefts.
  • Iliac cartilage grafts in unilateral cases correlated with fewer secondary rhinoplasties at skeletal maturity (P=0.0024).

Conclusions:

  • ICR provides significant immediate aesthetic and functional improvements in cleft nasal deformities.
  • Iliac crest cartilage grafting offers consistent, durable results for unilateral ICR, potentially beneficial with alveolar bone grafting.
  • PMM is a valuable tool for assessing ICR outcomes and guiding surgical techniques.