Primary Septal Cartilage Graft for Unilateral Cleft Rhinoplasty: 10-Year Follow-Up Results and the Effect on Septal Deviation

Overview

In infants with a unilateral cleft lip and palate, a small septal cartilage graft can be placed under the cleft-side nostril rim at the primary repair to improve symmetry. Short-term results were known; this study from Chang Gung's craniofacial centre compares 23 grafted and 37 non-grafted patients at 10 years, using nostril measurements, nasolabial angle, tip projection ratio and cephalometric septal deviation.

Sections of note

• 60 patients with unilateral complete cleft lip and palate; 23 grafted, 37 not.
• The medial one-quarter of nostril height was higher in the graft group (P = 0.031).
• Overall symmetry consistency did not differ significantly between groups.
• Nasolabial angle and tip projection ratio, used as nasal growth measures, did not differ.
• The graft group had a smaller septal deviation angle and length (P < 0.001).

What it means for a patient

• Taking a small piece of septal cartilage in infancy did not impair nasal growth over 10 years in this study.
• The graft gave a modest symmetry benefit at the inner nostril and was associated with a straighter septum.
• Overall nose symmetry at 10 years was similar with or without the graft.

Why this paper matters

Ten-year follow-up data on cleft rhinoplasty techniques are rare, and growth disturbance is the main concern with early septal surgery. Limits: retrospective, unequal groups, and the graft decision was not randomised.

Terms

• Cleft lip nasal deformity: the flattened, asymmetric nostril and tip that accompany a cleft lip.
• Primary rhinoplasty (cleft): nasal correction done at the time of the infant lip repair.
• Alar rim graft: cartilage placed along the nostril edge to support and shape it.
• Cephalometry: standardised skull X-ray measurement.
• Nasolabial angle: the angle between the upper lip and the columella.