Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty

Background Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes. Materials and Methods Balance between AP nostril diameters was accomplished by reduction of the AP diameter of the nostril at the non-cleft side by medial crural reduction and augmentation of the AP diameter of the nostril at the cleft side by three-parted mini-flap reconstruction at the soft triangle. The cleft-side AP diameter length was divided by the non-cleft-side AP diameter length of the same preoperative, per-operative and 1-year postoperative base view photographs of each patient, and nostril balancing ratio was obtained. The more this ratio was near to one, the more the AP nostril diameters were equal. Results Seventy-eight unilateral-cleft rhinoplasty were performed between January/2019 and May/2022. Forty-two of them required nostril AP diameter equalization. Twenty-nine patients were female, thirteen were male. Thirty-three of them were operated for a primary cleft rhinoplasty. Nine of them for secondary cleft rhinoplasty. Mean age was 28 years (22-39 years). Mean follow-up was 25 months (6-40 months). The preoperative, per-operative and postoperative mean nostril balancing ratios were 0.714 (0.621-0.813), 0.743 (0.721-0.752) and 0.971 (0.943-0.976), respectively. Conclusion Balancing AP diameter symmetry with MCO at the non-cleft side and three-parted mini skin flap reconstruction at the cleft side may provide the satisfactory results. Three mini-flaps at the soft triangle may remold the nostril apex in an oval shape, which may result in a better shape symmetry.

Automated summary

This study designed a technique to balance the anteroposterior diameter lengths and apical shapes of cleft rhinoplasty patients' nostrils. The technique involved reducing the diameter of the non-cleft side nostril and augmenting the diameter of the cleft side nostril using a three-parted mini-flap reconstruction. The results showed that this technique can provide satisfactory outcomes and achieve better shape symmetry.