Component Primary Unilateral Cleft Rhinoplasty: Balancing Dynamics of Overcorrection and Relapse

Primary rhinoplasty (PR) to correct the cleft nasal deformity at the time of unilateral cleft lip repair seeks to achieve durable improvement of nasal symmetry and projection. However, neither the components of primary cleft rhinoplasty nor their expected outcomes are well-established. This study presents a component-based cleft rhinoplasty technique and compares immediate to intermediate-term results.

The following 6 components of cleft nasal deformity are addressed: absent (1) nasal floor and (2) nasal sill, (3) tethered and malrotated alar base, (4) deviated caudal septum, (5) dysmorphic alar rim, and (6) deficient tip. Technical maneuvers to counteract each component are presented. Subjects who underwent component PR between 2018 and 2024 were retrospectively reviewed. Anthropometric measurements on standardized 2D and 3D photographs preoperatively, immediately postoperatively, and 1 year postoperatively were compared.

Complete photographic data were present for 29 subjects with unilateral cleft lip and nasal deformity. Symmetry from preoperatively to immediately postoperatively increased for most measures, including nostril width (1.95 ± 0.63 vs 0.95 ± 0.15), nasal base width (1.75 ± 0.50 vs 0.99 ± 0.14), columellar height (0.77 ± 0.20 vs 1.13 ± 0.27), and alar height (0.82 ± 0.17 vs 1.02 ± 0.16; each P  < 0.05). Columellar deviation angle similarly decreased (14.09°± 7.7° vs 6.3°±2.3°, P  < 0.05). Each of these measures remains significantly improved from preoperatively to 1 year postoperatively. However, from immediately to 1 year postoperatively, multiple anthropometric measures of symmetry showed recapitulation toward the original deformity, including: nostril width (0.95 ± 0.15 vs 1.15 ± 0.23), nasal base width (0.99 ± 0.14 vs 1.16 ± 0.22), columellar height (1.13 ± 0.27 vs 0.91 ± 0.17), and alar height (1.02 ± 0.16 vs 0.88 ± 0.07; each P  < 0.05).

Component PR improves symmetry in the immediate and extended postoperative period. However, multiple measures, including alar and columellar height as well as nasal base and nostril width all show approximately 20% relapse over the first year postoperatively. Overcorrection by approximately 20% may therefore be beneficial to optimize long-term symmetry.