Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

Background: Since 2006, the authors have explored the option of using septal cartilage as an alar rim graft on the cleft side during primary rhinoplasty to improve nasal symmetry. The aim of this study was to compare the nasal shape with or without rim graft. Methods: A total of 98 patients with unilateral complete cleft lip and palate were included; 39 patients had septal cartilage as the rim graft, and 59 patients did not. Measurements of the nostril height, nostril width, one-fourth medial part of nostril height, nostril area, nasal dome height, and nostril axis were obtained on the cleft and noncleft sides. Ratios of these measurements were calculated. These ratios were then compared between the graft and nongraft groups. The levels of asymmetry were categorized into four levels - less than 5 percent, 5 to 10 percent, 10 to 15 percent, and greater than 15 percent - based on the percentages deviated from perfect symmetry (100 percent). Panel assessment was also performed. Nasolabial angle and tip projection ratio were measured for the comparison of nasal growth. Results: The nostril height, height-to-width ratio, and nasal dome height were higher in the graft group (p = 0.003, p < 0.001, and p < 0.001, respectively). The graft group showed more consistency regarding the nostril shape and axis, and the differences were statistically significant (p < 0.05). The nasolabial angle and tip projection ratio showed no significant difference between the two groups. Conclusion: This preliminary study suggests that the use of a primary septal cartilage graft may offer better support at the alar rim and improve the long-term outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.