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

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.