Secondary Unilateral Cleft Rhinoplasty Using Natural Curvature of Rib Cartilage as Alar Rim Graft: A Three-Dimensional Evaluation of Long-Term Results

Overview

In a one-sided cleft the affected nostril is flatter and wider than the other. Since 2012 the senior author has used rib cartilage cut to keep its natural curve as a rim graft, alongside diced cartilage. This study measured how symmetric the noses became using three-dimensional imaging.

Sections of note

• 47 consecutive patients who had secondary unilateral cleft rhinoplasty from 2012 to 2018 were reviewed; 16 with both preoperative and postoperative 3D photographs taken at least 6 months after surgery were included.
• Imaging used the 3dMDface system; measurements were made in SimPlant O&O software.
• Parameters measured: nostril heights and widths, nasal dorsum heights, alare width, nostril areas, overlapping nostril area, tip protrusion, nasal length and nasal height.
• Nostril height ratio improved from 0.79 to 0.93; nostril width ratio from 1.24 to 1.06; nasal dome height ratio from 0.84 to 0.97, all significant.
• Overlapping nostril area ratio improved from 72.33 percent to 83.91 percent.
• Nasal tip protrusion-width index improved from 0.48 to 0.57; nasal index from 0.81 to 0.74.
• Level of evidence IV, therapeutic; the authors describe it as a preliminary study.

What it means for a patient

• Symmetry between the two nostrils improved substantially, with ratios moving from around 0.8 toward 1.0, where 1.0 is identical.
• Using the rib's natural curve avoids carving a curve, which the authors imply reduces the tendency to warp.
• Only 16 of 47 treated patients had both sets of 3D photographs, so the measurements cover a third of the series.
• Limits: retrospective, no comparison group, one team, and follow-up stated only as at least 6 months.

Why this paper matters

Cleft nostril asymmetry is the feature most visible to others and the hardest to correct durably. Objective 3D measurement is stronger evidence than photographic impression. The small measured subgroup and the absence of a comparison technique limit the conclusions.

Terms

• Secondary cleft rhinoplasty: Nose surgery after the original cleft repair, later in life.
• Alar rim graft: A small cartilage strip placed along the nostril edge to support it.
• Three-dimensional stereophotogrammetry: Building a 3D surface model from multiple simultaneous photographs.
• Nasal dome: The high point of the tip cartilage on each side.
• Nasal index: The ratio of nasal width to nasal height.