Tip Support in the Cleft Lip Rhinoplasty: A Comparison of Septal Extension Graft and Columellar Strut Graft

Muhammed Furkan Acil; Arda Kucukguven; Mert Calis; Fatma Figen Ozgur

doi:10.1007/s00266-023-03533-6

Tip Support in the Cleft Lip Rhinoplasty: A Comparison of Septal Extension Graft and Columellar Strut Graft

Aesthetic Plast Surg. 2024 Apr;48(7):1306-1311. doi: 10.1007/s00266-023-03533-6. Epub 2023 Aug 11.

Authors

Muhammed Furkan Acil¹, Arda Kucukguven², Mert Calis², Fatma Figen Ozgur²

Affiliations

¹ Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey. acilfurkan@gmail.com.
² Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

PMID: 37567945
DOI: 10.1007/s00266-023-03533-6

Abstract

Background: We aimed to comparatively analyze nasal projection and rotation changes in patients that underwent secondary cleft rhinoplasty with a columellar strut graft (CSG) or septal extension graft (SEG).

Methods: Thirty-three patients were randomly divided into two groups. Preoperative, intraoperative (immediate postoperative), postoperative 1-, 6- and 12-month profile view pictures were analyzed. The nasion (N), alar base-cheek junction (A), tip defining point (T), columella (C), and lips (L) were marked. The AT/AN ratio, NAT angle, Goode ratio, and columellar-labial angle (CLA) were measured.

Results: Regarding tip projection, the AT/AN ratio was lower in CSG group compared to SEG group postoperatively. In CSG group, there was a significant progressive decrease in the AT/AN ratio, whereas in SEG group, it decreased until postoperative 6 month. Regarding tip rotation, the NAT angle was higher in CSG group postoperatively and increased progressively. In SEG group, the NAT angle was lower intraoperatively compared to the postoperative period, whereas it did not differ significantly in-between follow-ups. The Goode ratio was significantly lower in CSG group compared to SEG group postoperatively. In SEG group, the Goode ratio was significantly higher intraoperatively compared to the postoperative period, but it did not differ significantly in-between follow-ups. In CSG group, the Goode ratio decreased progressively. The CLA decreased in both groups, but there was no statistically significant difference between the groups.

Conclusion: Secondary cleft lip rhinoplasty is a distinct subgroup of rhinoplasty that necessitates stable and strong tip support. SEG provides more reliable and predictable long-term results in secondary cleft lip rhinoplasty than CSG.

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Keywords: Cleft lip; Columellar strut graft; Nasal projection; Nasal tip rotation; Rhinoplasty; Septal extension graft.