P74. A HIP WAY TO RECONSTRUCT NOSES: OUTCOMES WITH ILIAC CREST CAP CARTILAGE GRAFTS IN INTERMEDIATE CLEFT RHINOPLASTY

Abstract

PURPOSE: This case-control study evaluated the trends and outcomes of iliac crest cap cartilage (ICCC) grafts in an intermediate mixed-dentition (IMD) cohort undergoing cleft rhinoplasty. METHODS: From 2006 to 2020, our institution performed 959 cleft rhinoplasties, 304 during IMD of which 140 underwent tip rhinoplasty with ICCC grafts concomitantly with alveolar bone grafting. Appropriate cohort and subgroup statistical analyses and regression modeling were completed. Photomorphometric (PMM) analyses on basal, frontal and lateral views were conducted comparing cohorts with and without ICCC grafts and assessing nasal symmetry, protrusion and nasolabial angles. RESULTS: There were no statistically significant differences between the ICCC cohort and controls regarding sex, cleft laterality, or surgical age (all p>0.1). There was a statistically significant increase in institutional use of ICCC over time (p<0.001), without correlation to sex, laterality, or age at surgery (all p>0.05). Within a subgroup of now skeletally mature patients, the prior use of ICCC was significantly correlated with a decreased incidence of requiring further rhinoplasties (φ=0.2195; p=0.0176). PMM analyses demonstrated the unilateral cleft ICCC cohort had superior improvement in nasal symmetry postoperatively relative to controls (p=0.0277) but was otherwise comparable to controls, in nostril symmetry (p=0.696) and tip projection (p=0.334). No patients had iliac crest contour irregularities with functional sequelae. CONCLUSION: ICCC provides an abundant source of cartilage for cleft rhinoplasty in the period of IMD concomitant to alveolar bone grafting. Our data demonstrates comparable or improved aesthetic outcomes with ICCC without additional morbidity and provides reassurance on ICCC’s retention over time.