Asian Cleft Rhinoplasty: The Open Structural Approach

Overview

Cleft nasal deformity in Asian patients combines the asymmetry of the cleft with a lower bridge and weaker cartilage. This paper describes a technique that rebuilds the misplaced tip cartilages and lengthens the nose using only the patient's own tissue, with no synthetic implant.

Sections of note

• 35 patients operated from January 2010 to December 2015: 18 female, 17 male; 29 unilateral clefts and 6 bilateral; mean follow-up 23 months.
• Central support: a septocolumella graft fixed securely in the midline with extended spreader grafts, to project and lengthen the nose.
• The displaced lateral crus on the cleft side was fully detached from the accessory cartilages and freed from the vestibular lining.
• The deficient medial crus was lengthened using the lateral crural steal procedure.
• The resulting shortened lateral crus was rebuilt with a lateral crural strut graft.
• Tip suturing and grafting were performed; the bridge was augmented with diced cartilage wrapped in deep temporal fascia.
• At closure, a modified Tajima reverse-U excision of the vestibular lining corrected alar hooding on the cleft side where indicated; alar base changes were made as needed. Level of evidence 4.

What it means for a patient

• Nothing synthetic is used; all material comes from the patient's own septum, rib, ear, or scalp fascia.
• The tip cartilage on the cleft side is fully released and repositioned rather than merely propped up.
• Limits: 35 patients, one team, no comparison group, satisfaction reported without a stated measurement tool, and complication and revision rates described as low without numbers.
• Mean follow-up of 23 months is short for judging whether a rebuilt cleft nose holds its shape.

Why this paper matters

Cleft rhinoplasty in Asian patients has often relied on implants for the low bridge, and this reports a fully autologous alternative. The technique sequence is set out in detail. Without measured outcomes or a comparison arm, the claim of superiority over the team's previous approach is not quantified.

Terms

• Autologous: Taken from the patient's own body.
• Lateral crus: The outer arm of the tip cartilage.
• Medial crus: The inner arm of the tip cartilage, running down into the columella.
• Lateral crural steal: Advancing part of the outer arm to lengthen the inner arm and raise the tip.
• Alar hooding: Excess nostril rim tissue hanging downward.