Definitive Cleft Rhinoplasty: A 15-Year Single-Institution Review of Surgical Techniques and Outcomes

Definitive cleft rhinoplasty is performed at or near skeletal maturity to improve nasal breathing, symmetry, and shape, with surgeons performing a variety of techniques depending on patient goals. This study explores the relationship between specific surgical maneuvers and resulting anthropometric changes to the nose and adjacent structures. The authors performed a retrospective cohort study of patients with cleft lip and/or palate who underwent definitive or revision rhinoplasty, defined as surgery performed at age 12 or above, at our institution between 2006 and 2023. Two hundred fifty-nine patients, spanning 308 definitive rhinoplasties, were included in our cohort. Use of 24 different surgical maneuvers during rhinoplasty was collected and correlated with preoperative and postoperative anthropometric measurements. The mean age at definitive rhinoplasty in our cohort was 16.9±4.4 years. Older age at first operation and use of both internal and external splints were associated with decreased need for subsequent rhinoplasty. Use of rib cartilage grafting was significantly associated with need for additional revision rhinoplasty (P=0.0058) and 90-day complications (OR: 5.672, P=0.018). Rib cartilage grafting was independently associated with an increase in nasolabial angle (β: 18.8671, P=0.029), and the columellar strut was independently associated with decreases in nasal base asymmetry (β: -0.0793, P=0.0238) and nostril shape irregularity (β: -0.1685, P=0.0142). Numerous surgical techniques are used in definitive cleft rhinoplasty to optimize aesthetic and functional outcomes. Understanding of both the intended primary and often unintended secondary effects of each maneuver is critical in planning the optimal operation for patients with cleft nasal deformities.