Retrospective Review of Open Tip Plasty for Bilateral Cleft Nasal Deformity before Adolescent Growth: A Single Surgeon’s Experience of 25 Consecutive Cases

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BACKGROUND: Primary tip rhinoplasty at the time of bilateral cleft lip (BCL) repair has become the standard of care. However, there are limitations in fully correcting the interdomal deformity, resulting in variations in early nasal tip shape. The authors offered BCL patients who demonstrated unfavorable nasal tip growth after BCL repair an open tip rhinoplasty at 3-5 years of age. This study retrospectively compared basic nasal morphometrics in these patients relative to matched controls who did not have the surgery. METHODS: Nasal tip projection and nostril height to width ratios were measured for 25 consecutive patients who underwent early open tip rhinoplasty using standardized submental and lateral photographs over time. Twenty-five historical controls who did not undergo the surgery but had similar starting nasal morphology to the surgery group were matched by ethnicity and sex. The measurements were plotted to demonstrate trends in the 2 groups over time. RESULTS: Both tip projection and relative nostril height were comparable between the 2 groups after primary lip-nose repair but before any secondary nasal surgery. Immediately after surgery, the study group had greater tip projection and relative nostril height than before surgery, and these measures remained stable or improved over time. The historical control group measurements did not exhibit appreciable change from baseline over time. CONCLUSIONS: In carefully selected BCL patients demonstrating unfavorable nasal growth before adolescence, open tip rhinoplasty improves both relative nostril height and tip projection relative to comparable patients who did not undergo the procedure. Further studies are required to determine whether this early intervention can improve patient satisfaction through school-age years and decrease the need for definitive rhinoplasty at maturity.

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