Technique And Morphologic Evaluation Of Component Restoration In The Bilateral Intermediate Cleft Tip Rhinoplasty
Brian N. Dang, BS, Allison C. Hu, BA, Anthony A. Bertrand, MD, MBDA, Candace H. Chan, BS, Phoebe Hung, BS, Hi'ilani M.K. Potemra, Bs, Vicky Kang, MD, Justine Lee, MD, PhD.
University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
PURPOSE: The bilateral cleft nose (BCN) deformity is characterized by a broad nasal tip and shortened columella due to structural defects that include cartilage weakness and malpositioning, in addition to nasal vestibular lining deficits. Corrective rhinoplasty to address anomalies of the BCN is stratified into the primary, intermediate, and secondary phases. This study describes a novel intermediate cleft tip rhinoplasty (ICTR) component restoration technique for BCN and includes an evaluation of the chronologic postoperative morphometric changes for surgical patients in comparison with non-operated age-matched controls. METHODS: The ICTR component restoration technique involves repositioning and fixation of the bilateral cleft lower lateral cartilages through composite auricular cartilage grafting to address BCN lining and structural anomalies. Photographic analysis of patients with BCN who had ICTR (n=12) and age-matched controls who did not have ICTR (n=8) were assessed at timepoints T0 = preoperative, T1= less than 2 years postoperative, T2 = more than 2 years postoperative. Evaluation includes alar symmetry, nasal tip projection, nostril dimensions, nasofacial angle, and facial symmetry. Independent sample T-tests compared morphometric measurements of ICTR patients to control groups at T0 to assess baseline morphology. One-way analyses of variance with posthoc corrections using the Tukey criterion were performed to compare morphometrics over all time points. P<0.05 was considered statistically significant.
RESULTS: No significant differences in any demographic characteristics were found between the two groups. At baseline, ICTR patients had decreased nasal tip projection (40.2±9.5 vs 50.8±9.8, p=0.03). No differences were seen in alar symmetry, nostril dimensions, nasofacial angle, or facial symmetry. ICTR technique resulted in statistically significant improvements in nasal tip protrusion based on nasofacial angle representing lateral view (32.9±4.7 vs 37.5±4.9, p=0.04) and nasal tip projection representing basal view (40.2±9.5 vs 51.7±6.6, p=0.04), in addition to improvements in nostril dimensions (67.7±14.4 vs 81.9±12.8, p=0.02) when comparing timepoints T0 with T2. On the other hand, non-operated control patients did not demonstrate statistically significant changes in any morphometrics. CONCLUSION: Baseline assessment reveals a greater degree of nasal deformity for patients who received ICTR. Also, this technique improves bilateral cleft nasal tip protrusion that is sustained over time. In contrast, patients who did not receive ICTR did not show improvements in nasal morphology, suggesting that these changes were not secondary to growth.
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