Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

Overview

In a one-sided cleft the nostril on the cleft side is typically flattened and wider. Since 2006 the authors have placed a small strip of septal cartilage along the nostril rim on that side at the time of the first rhinoplasty. This study compared nose shape measurements between children who had that graft and those who did not.

Sections of note

• 98 patients with unilateral complete cleft lip and palate; 39 received a septal cartilage rim graft and 59 did not.
• Measurements on both sides: nostril height, nostril width, the medial quarter of nostril height, nostril area, nasal dome height, and nostril axis; ratios were compared between groups.
• Asymmetry was grouped into four levels by deviation from perfect symmetry: under 5 percent, 5 to 10, 10 to 15, and over 15 percent.
• Nostril height, height-to-width ratio, and nasal dome height were higher in the graft group, p 0.003, p below 0.001, and p below 0.001.
• The graft group showed significantly more consistency in nostril shape and axis, p below 0.05.
• Nasolabial angle and tip projection ratio showed no significant difference. Level of evidence III.

What it means for a patient

• A small cartilage graft at the first operation gave a taller, better supported nostril on the cleft side.
• Growth measures did not differ, which addresses the concern that early cartilage work restricts development.
• Results were more uniform in the graft group, meaning less variability between children.
• Limits: not randomized, outcomes are photographic measurements rather than patient-reported, and the authors call it a preliminary study.

Why this paper matters

The main worry about operating on the cleft nose in infancy is interference with growth, and this study found no growth difference while showing shape gains. Longer follow-up through adolescence is needed to confirm the advantage persists.

Terms

• Unilateral cleft lip and palate: A cleft affecting one side of the lip and the roof of the mouth.
• Alar rim graft: A small cartilage strip placed along the nostril edge to support it.
• Septal cartilage: Cartilage taken from the central wall of the nose.
• Nasal dome: The high point of the tip cartilage on each side.
• Nasolabial angle: The angle between the base of the nose and the upper lip.