Photomorphometric Analysis-based Surgical Outcomes in Intermediate Cleft Rhinoplasties: An 18-Year Experience.

[BACKGROUND] Intermediate cleft rhinoplasty (ICR) addresses nasal deformities in children with cleft lip and/or palate (CL/P), yet the influence of surgical planning and outcomes remains underdefined. This study evaluates decision-making and postoperative outcomes using quantitative photomorphometric analysis (PMM), with emphasis on graft selection, positioning, and suture techniques in unilateral and bilateral cleft nasal deformities.

[METHODS] A retrospective review was performed of all nonsyndromic children with cleft lip and/or palate (CL/P) who underwent ICR between 2006 and 2023. Operative data included concomitant procedures, graft type, positioning, and suture method. PMM was based on standardized basal, frontal, and lateral photographs quantified nasal symmetry and projection.

[RESULTS] Of 317 patients, 128 had adequate photography for PMM. In patients with unilateral clefts, greater preoperative asymmetry and poor projection were predictive of cartilage grafting, with iliac cartilage being the preferred choice. Immediate postoperative PMM showed significant improvements in symmetry and protrusion across most techniques (P<0.01), especially with iliac cartilage and cleft-side alar batten grafts. Interdomal sutures significantly enhanced projection. In bilateral cleft cases, graft choice was less predictable, but less severe asymmetry correlated with tip onlay graft use. The modified Potter V-Y advancement flap improved symmetry and projection. At skeletal maturity, unilateral patients with iliac cartilage grafts required fewer secondary rhinoplasties (P=0.0024). No significant donor site morbidity was observed.

[CONCLUSIONS] ICR offers significant immediate improvements in nasal symmetry and protrusion when aligned with preoperative severity. Iliac crest cartilage grafting yields consistent and durable results in unilateral cleft rhinoplasty, and may be worthwhile when concomitant to planned alveolar bone grafting.