# Surgical procedures for nasal deformity in patients with cleft lip and palate

## TL;DR

This study compares two surgical techniques for correcting nasal deformities in cleft lip and palate patients, finding one more effective for nasal tip shape.

## Contribution

The study introduces a septal extension graft technique as a more effective alternative to conventional suture methods for nasal tip morphology in cleft rhinoplasty.

## Key findings

- The septal extension graft group showed significantly better nasal tip morphology in frontal and basal views (P<0.001).
- No significant differences in symmetry improvement were observed between the two techniques for front and bottom views.
- The graft technique resulted in decreased nasal tip mobility compared to the conventional method.

## Abstract

External nasal deformity in patients with cleft lip and palate causes both functional and aesthetic problems. Corrective rhinoplasty using a reverse U-shaped incision and suturing of the alar cartilage is not always successful. Therefore, we compared the use of a newer septal extension graft technique with the conventional suture technique to determine an effective surgical method for improving nasal tip morphology.

We compared the outcomes of the conventional reverse U-shaped incision technique with the septal extension graft in 12 patients undergoing secondary cleft rhinoplasty (6 in each group). Ten plastic surgeons evaluated 6-month postoperative photographs using six criteria: nasal tip shape (frontal, lateral, and basal views), left–right asymmetry (frontal and basal views), and overall improvement. Each item was rated on a 4-point scale (1=poor, 4=excellent). Mann–Whitney U tests were used to assess statistical significance.

The septal extension graft group showed significantly better nasal tip morphology in the frontal and basal views (P<0.001) and in the lateral view (P=0.007). However, there were no significant differences in symmetry improvement between the two techniques for the front (P=0.685) and bottom (P=0.602) views.

Corrective rhinoplasty using a septal extension graft can significantly improve nasal tip morphology in cleft lip cases compared with the reverse U-shaped incision and alar cartilage suturing technique. However, decreased mobility of the nasal tip was noted. Further improvement is needed in terms of patient-reported satisfaction and postoperative stability.