“Stuffy Nose” Rhinoplasty: Diced Cartilage Grafts for Correction of Cleft Nasal Tip Deformities

Abstract

Numerous techniques exist to address poor nasal tip projection in the cleft nose deformity. The authors describe a secondary closed rhinoplasty technique using diced cartilage nasal tip grafting. Cleft patients who previously underwent lower lateral cartilage repositioning with residual poor nasal tip projection underwent the "stuffy nose" rhinoplasty technique in which diced septal cartilage grafts were placed in a pocket made from a unilateral marginal incision over the lower lateral cartilages. Preoperative and follow-up (1 year) comparative measurements included (1) columellar length, (2) alar base-nasal tip-columellar base angle, and (3) lateral tip projection. Twenty cleft patients had improvement in nasal form and tip projection from the stuffy nose rhinoplasty. Mean change from preoperatively to follow-up was as follows: columellar length, 11.3 mm to 13.3 mm (17.7 percent); alar base-nasal tip-columellar base angle, 42.0 to 33.5 degrees (8.5 degrees, or 20.2 percent decrease); and lateral tip projection, 7.7 mm preoperatively to 9.0 mm postoperatively (16.9 percent increase). Two patients developed complications (one graft exposure and one infection) but healed with conservative treatment. Two different patients underwent revisionary nasal surgery but for other concerns (alar base asymmetry and internal nasal valve collapse). The stuffy nose rhinoplasty was shown to objectively improve nasal tip projection in cleft patients with secondary nasal deformities, with minimal complications and decreased need for revisions.