Component Restoration in the Unilateral Cleft Tip Rhinoplasty: Technique and Longevity
Julia R. Ayeroff, BA1, Elizabeth J. Volpicelli, BA1, Rachel S. Mandelbaum, MD1, Samuel Asanad, MD1, Miles J. Pfaff, MD1, David S. Foulad, MD1, Thomas Willson, MD1, James P. Bradley, MD2, Justine C. Lee, MD, PhD1.
1Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA, 2Division of Plastic and Reconstructive Surgery, Temple University Hospital, Lewis Katz School of Medicine, Philadelphia, PA, USA.
PURPOSE: Approaches to systematically address deficient tissue components have not been thoroughly investigated in the unilateral cleft nasal tip correction. We describe and evaluate long-term outcomes of a component restoration technique performed during mid-childhood that simultaneously addresses cleft lower lateral cartilage (LLC) positioning, cleft LLC hypoplasia, and lining deficiency.
METHODS: The component restoration technique involves: 1.Composite release and repositioning of the cleft LLC and nasal lining, 2.Composite skin/cartilage auricular graft for LLC support and to replace the lining deficit, 3.Tip suturing. Photographs of children with unilateral cleft nose (UCN) anomalies (n=50) treated with component restoration (n=29) were evaluated preoperatively (t0) and postoperatively: <1 year (t1), 1-3 years (t2), and >3 years (t3) and compared to age-matched UCN controls (n=21). Alar symmetry, nasal tip protrusion, and nostril dimensions were determined at each timepoint using basal view photographs and analyzed using a linear mixed-effect model.
RESULTS: Component restoration UCN correction improved alar symmetry, increased nasal tip protrusion, and decreased nostril width/height at t1, t2, and t3 compared to t0 (p <0.001). No differences were detected in control UCN suggesting that these changes were unrelated to age-dependent growth. At t3, children who underwent component restoration tip rhinoplasties demonstrated improved nasal tip protrusion compared to control UCN children (p=0.002).
CONCLUSION: The component restoration technique in unilateral cleft tip rhinoplasty in mid-childhood improves alar symmetry, nasal tip protrusion, and nostril dimensions. Such improvements are sustained for at least three years postoperatively and are unrelated to age-dependent changes in cleft nasal development.
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