Secondary unilateral cleft rhinoplasty utilizing natural curvature of rib cartilage as alar rim graft: a 3 dimensional evaluation of long term results

BACKGROUND:Since 2012, the author incorporates the natural curvature of rib cartilage as alar rim graft in addition to diced cartilage technique for unilateral cleft rhinoplasty. The aim of this study is to describe this modification and evaluate its long term results regarding nasal symmetry using 3-dimensional (3D) stereophotogrammetric assessment (3dMDface system). METHODS:From 2012-2018, 47 consecutive patients that undergone secondary unilateral cleft rhinoplasties were retrospectively reviewed. 16 patients that have both preoperative 3D photos and postoperative 3D photos taken at least 6 months after the operation were included. SimPlant® O&O software was utilized to measure parameters on 3D photosnostril heights, nostril widths, nasal dorm heights, alare width, nostril areas, overlapping nostril area, nasal tip protrusion, nasal length and nasal height before and after operation. The ratio between cleft and non-cleft sides were calculated. In addition, the overlapping nostril area ratio, tip protrusion-width index and nasal index were compared before and after operation. RESULTS:The preoperative nostril height ratio (0.79), nostril width ratio (1.24), and nasal dorm height ratio (0.84) between cleft and non-cleft sides were significantly improved after operation to 0.93, 1.06 and 0.97 respectively. The preoperative overlapping nostril area ratio (72.33%), nasal tip protrusion-width index (0.48) and nasal index (0.81) also showed significant improvement postoperatively to 83.91%, 0.57 and 0.74. CONCLUSION:This preliminary study supports the use of natural curvature of rib cartilage as alar rim graft in secondary unilateral cleft rhinoplasty, with long term improvement regarding nasal symmetry and nasal profile.