Unilateral Cleft Nasal Deformity Research Articles

5-year Long-term Outcome of Unilateral Cleft Rhinoplasty in Patients with Secondary Nasal Deformity: Optimal Indication of Tajima Technique.

This study aimed to investigate the timing of and indications for the Tajima reverse U incision for correcting secondary unilateral cleft nasal deformities. Non-syndromic patients with secondary cleft lip and nasal deformity who received Tajima reverse-U incision rhinoplasty were grouped by age (4-13 years, n=56;13-18 years, n=22; >18 years, n=18) and severity of deformity (mild deformity, n=7; moderate deformity=22; severity deformity=67) during 5-year follow-up. Face-Q assessment, a rating scale, and nasal symmetry measurements were employed in this study. Ninety-six patients completed the FACE-Q assessment for the nose and nostril. The results showed higher satisfaction with nostril appearance 1-week after surgery (85.95±13.01) compared with pre-operation (79.72±11.89) and maintained 5-year follow-up (82.61±14.06). Significant differences were observed in five nasal parameters (nasal height ratio, one-fourth media part of nostril height ratio, nasal sill height ratio, columellar angle, and inner nostril height-to-width ratio (cleft)) for 1-week postoperatively and the corrected outcome of the Tajima technique was maintained 5 years after surgery in aged 4-13 years group. The same statistically significant changes were found in nasal sill height ratio in mild deformity group and nostril width ratio, one-fourth media part of nostril height ratio, columellar angle, and inner nostril height-to-width ratio (cleft) in moderate deformity group. The Tajima procedure was beneficial for preadolescent children and children with mild to moderate unilateral cleft nasal deformities.

Correction of Cleft Lip Nose Deformity With Circular Shape Alar Graft and Block Costal Cartilage.

Secondary deformities of the cleft lip and nose are mainly caused by the long period of craniofacial development and the secondary scarring. Correction of the secondary cleft lip-nose deformity is a complex process that requires both the correction of the soft tissue and skeletal support. The purpose of this study was to present our experience in correcting the secondary unilateral cleft lip-nose deformities with autologous costal cartilage. A retrospective analysis of patients who underwent correction of unilateral cleft nasal deformity with simultaneous rhinoplasty by a senior surgeon from January 2015 to January 2022 was conducted. Preoperative and postoperative measurements of the columellar-labial angle and the inclination of nasal base were conducted to evaluate the surgical outcomes. A total of 54 patients were included in this study according to the inclusion criteria. The mean follow-up period was 4 years (range, 1-7 years). The mean values of the columellar-labial angle were 91.1 ± 9.2 degrees preoperatively and 101.0 ± 5.9 degrees postoperatively. The mean values of the inclination of nasal base were 4.5 ± 1.2 degrees preoperatively and 0.9 ± 0.4 degrees postoperatively. There was a considerable increase in the columellar-labial angle after the surgery (9.9 ± 6.0 degrees; P < 0.01). The inclination of nasal base decreased significantly (3.6 ± 1.1 degrees; P < 0.01). Our approach on correction the secondary clef lip nose through repositioning the muscles by Z-plasty and application of the block cartilage graft and circular shape alar graft has achieved long-term satisfactory results.

Three-dimensional Anthropometric Analysis of Racial and Ethnic Differences in Unilateral and Bilateral Cleft Nasal Deformity.

This study used three-dimensional measurements to provide a nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across different races and ethnicities. A retrospective comparative study. Tertiary care pediatric institution. The study included 90 patients with UCLP, 43 patients with BCLP, and 90 matched controls. Patients are separated as self-identified Caucasian, Hispanic, or African American. Nasal length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width. All UCLP groups had significantly greater columella and tip widths and decreased nasolabial angles than controls. All BCLP groups had significantly greater columella width, tip width, nasolabial angle, and nostril widths. Upper lip length, philtrum length, and nostril height were significantly decreased in BCLP compared to controls. Across UCLP groups, African Americans had significantly decreased nasal protrusion and columella height and a significantly increased columella width compared to Caucasians and Hispanics. Alar and alar base widths were significantly different between all groups. Across BCLP groups, the Caucasian nostril width was significantly less than the African Americans. These findings suggest that when correcting nasolabial characteristics in patients with cleft lip, it is important to consider racial and ethnic differences to achieve a normal appearance. Specifically, goals for alar width, alar base width, nasal tip, and projection should be tailored to the patient's race and ethnicity.

3D Infant Orthopedic Nasal Molding System for Improved Outcomes in Cleft Nasal Deformity

The cleft nasal deformity is a hallmark feature in infants with cleft lip and palate and includes deviation of the caudal septum, slumping of the ipsilateral lower lateral cartilage, and obstructed nasal breathing. Presurgical orthopedic protocols have been developed and refined over several decades now, with limited evidence supporting their long-term efficacy, particularly with respect to the nasal form. Some limitations relate to variabilities in studies and data outcome measures. We have designed a novel method of presurgical orthopedic molding using separate nasal and intraoral components. The independent nasal device, called the Rhinoplastic Appliance System, is introduced in this technique article and shown to have distinct biomechanical advantages for the unilateral and bilateral cleft nasal deformity, both presurgically before lip repair, and postsurgically for nostril maintenance. As with CAD/CAM technologies for the intraoral plate component of traditional NAMs, we believe digital preparation of RAS devices, combined with separate oral appliances, can allow for more effective and reproducible presurgical infant cleft molding with less operator dependence and family/patient burden.

A Single Stage Composite Cleft Septorhinoplasty for Correction of the Mature Unilateral Cleft Nose Deformity - The Gujrat Technique.

To evaluate the results of a single stage composite cleft septorhinoplasty procedure ("The Gujrat Technique") to correct the exaggerated cleft nose deformity after completion of nasal growth in an adult patient cohort. Adult patients with a residual unilateral cleft nasal deformity were deemed eligible for the proposed "Gujrat Technique". Over a 10-year period (2007-2017), 96 adult patients underwent this composite cleft septorhinoplasty as a single stage operation. Post-operative nasal symmetry evaluation was undertaken using the validated computer program 'SymNose'. Functional outcome and patient satisfaction were assessed using Nasal Obstruction Symptom Evaluation scale and Rhinoplasty Outcome Evaluation (ROE) questionnaires respectively. Various statistical analysis methods were used to validate the obtained results. Due to poor compliance with follow-up, post-operative assessments were undertaken in only 32 patients. The single group study design using the non-parametric matching pairs Wilcoxon Sign test (p < 0.001) showed overall good to excellent functional and aesthetic outcomes and higher scores of the digital SymNose grading system. There was a significant improvement in ROE scores (from 26.4 ± 2.9 to 85.9 ± 4.7, p < 0.001). There were no major complications or revisions needed in our series. The individual components of "The Gujrat Technique" are not novel but their combination in this adult unilateral cleft rhinoplasty cohort has demonstrated a high patient satisfaction with its aesthetic appeal and functional versatility. In the background of limited resources and unpredictable patient follow up, the simplicity, reproducibility and cost effectiveness of this technique make it a practical reconstructive option.

Efficacy of cartilaginous septal batten graft for septal stabilization in patients with unilateral secondary cleft nasal deformity: a pilot study

article: Efficacy of cartilaginous septal batten graft for septal stabilization in patients with unilateral secondary cleft nasal deformity: a pilot study - Otorhinolaryngology 2021 December;71(4):260-6 - Minerva Medica - Journals

Quantitative analysis of aesthetic outcomes of morphofunctional septorhinoplasty for secondary cleft lip nasal deformity

The main aim of this study was to assess nasal symmetry after morphofunctional septorhinoplasty, more specifically, symmetry of the alar base and nostrils, and nasal projection, in patients with unilateral and bilateral cleft nasal deformities. Secondary cleft rhinoplasty was performed using morphofunctional septorhinoplasty techniques in 150 patients with unilateral and bilateral cleft lip and nose deformities. Nasal changes were analysed by measuring nasal tip projection, nostril height, nostril width, alar base width, and nasal gap area preoperatively and postoperatively on standard submentovertex view 2-dimensional photographs. In the unilateral cleft group there were statistically significant improvements (p<0.001) in ratios of nasal height and width (p=0.024) and nasal gap area, and in nasal tip projection and alar base width. In the bilateral cleft group there were statistically significant improvements in nasal gap area ratio (p=0.009), nasal tip projection, and alar base width. The morphofunctional septorhinoplasty technique improved aesthetic outcomes.

Anterior Nasal Spine Relocation With Cleft Orthognathic Surgery.

In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome. Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline. The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 ± 1.0 mm versus 3.2 ± 1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 ± 12.6 versus 159.8 ± 7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 ± 11.7 versus 162.8 ± 7.7; P = 0.128). This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term.

Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity.

Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty. The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided. Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.

Discussion on Working in Peru: A 25-Year Experience With Voluntary Cleft Missions, and a Technique for the Primary Repair of the Unilateral Cleft Lip and Nasal Deformity.

Discussion on Working in Peru: A 25-Year Experience With Voluntary Cleft Missions, and a Technique for the Primary Repair of the Unilateral Cleft Lip and Nasal Deformity.

Three-Dimensional Anthropometric Analysis of Racial and Ethnic Differences in Unilateral and Bilateral Cleft Nasal Deformity

BACKGROUND: Prior studies have demonstrated variation in nasolabial indices across racial and ethnic groups. Anthropometric data on the racial and ethnic differences in the cleft nasal deformity at the age for definitive rhinoplasty can provide a foundation for operative planning. This study used three-dimensional stereophotogrammetry measurements to provide a comprehensive nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across multiple races and ethnicities. METHODS: A retrospective review of three-dimensional images of patients with UCLP and BCLP captured before orthognathic surgery or definitive cleft rhinoplasty was performed. The patients were separated by self-reported identifiers as Caucasian, Hispanic, or African American. Twelve measurements (millimeters) were collected: dorsum length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width. An equal number of age, sex, race, and ethnicity matched control patients were analyzed. Two-sample t tests were performed (P < 0.05). RESULTS: Total patients included 90 UCLP, 43 BCLP, and 90 controls. UCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width and lesser nasolabial angle than respective controls. Caucasian UCLP alar width (33.66 ± 3.12) and alar base width (33.66 ± 3.51) were significantly greater than matched controls (31.21 ± 2.54; 31.33 ± 2.18). Hispanic UCLP alar width (37.52 ± 3.46) and alar base width (36.77 ± 2.81) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08). African American UCLP alar width (41.63 ± 3.43) and alar base width (41.93 ± 3.78) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97). BCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width than respective controls. Caucasian BCLP alar width (37.66 ± 0.77), alar base width (38.06 ± 0.65), and nostril width (12.54 ± 1.68) were significantly greater than matched controls (31.21 ± 2.54, 31.33 ± 2.18, 10.34 ± 1.01). Hispanic BCLP alar width (38.75 ± 3.79), alar base width (38.73 ± 3.35), and nostril width (13.23 ± 2.13) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08; 11.92 ± 2.13). African American BCLP alar width (40.88 ± 3.92), alar base width (40.56 ± 3.97), and nostril width (13.01 ± 2.07) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97; 14.00 ± 1.45). Across UCLP groups the African American group had significantly less nasal protrusion (17.84 ± 1.38) and columellar height (8.96 ± 0.85) and significantly greater columellar width (9.56 ± 1.58) than Caucasians (20.18 ± 1.93, 10.57 ± 1.45, 8.48 ± 1.07), and Hispanics (21.14 ± 2.12, 10.83 ± 1.96, 8.26 ± 1.51). Caucasian alar width (33.66 ± 3.12), alar base width (33.66 ± 3.51), and affected nostril width (10.80 ± 1.51) were significantly lesser than Hispanics (37.52 ± 3.46, 36.77 ± 2.81, 12.04 ± 2.28) and the same measures in both Caucasians and Hispanics were significantly lesser than African Americans (41.63 ± 3.43, 41.93 ± 3.78, 13.96 ± 2.43). Across BCLP groups, there were no significant difference in measurements. CONCLUSIONS: The UCLP deformity differs between groups in alar width and alar base width. African Americans further differ in nasal protrusion, columellar height, and columellar width. The BCLP deformity does not differ between groups. The findings demonstrate that when correcting alar width, alar base width, tip refinement, and projection racially and ethnically congruent goals should be used to better approximate normal appearance.

Management of the Nasal Deformity in the Unilateral Cleft of the Lip and Nose.

Cleft rhinoplasty is a demanding, technique-sensitive procedure. Part art, part science; it poses several probing questions to the surgeon. The unilateral cleft nasal deformity is a distinct entity because the pursuit of symmetry in the unilateral cleft nose makes the repair much more challenging. The advent of nasoalveolar moulding, the gaining popularity of primary (early) nasal repair and greater refinements in secondary (definitive) rhinoplasty techniques have contributed to better nasal results in unilateral cleft repair. Yet, some obstacles remain. This paper aims to discuss the anatomy of the unilateral cleft nose, enumerate aims and objectives of repair at every stage, and to demonstrate the evolution and varied rationale of management of nasal deformities in the unilateral cleft lip and nose.

Cleft Rhinoplasty Study and Evolution.

Most patients with a cleft lip will have a cleft lip nasal deformity. The nasal deformities are complex and are difficult to surgically correct as a result of the anatomical issues and deficiencies. In this study, the authors analyzed and reviewed nasal pathology and surgical maneuvers in patients with cleft lip nasal deformity treated by the senior author over the past 15 years. A retrospective review was performed on patients who underwent a rhinoplasty for a cleft nasal deformity from the years of 2002 to 2017. Patients were stratified by unilateral and bilateral cleft lip. For each variable, comparisons were made between unilateral and bilateral cases. 39 patients had a unilateral cleft lip nasal deformity, while 17 had a bilateral cleft lip nasal deformity. Patients with a unilateral cleft nasal deformity had a significantly higher incidence of vestibular stenosis and septal deviation. Regarding surgical maneuvers, unilateral cleft lip patients had a relatively higher utilization of septoplasty, spreader grafts, and alar grafts compared to bilateral cleft lip patients. Bilateral cleft lip patients had a relatively higher utilization of dorsal hump reduction, columella strut grafts, and nasal tip grafts. These differences were not statistically significant. Unilateral cleft lip patients had a statistically significant higher use of alveolar support at the time of rhinoplasty. The rhinoplasty operation in patients with cleft lip nasal deformity is uniquely challenging and rewarding. This operation has undergone an evolution in our own practice and has led to improved outcomes for these patients.

Columellar strut graft in unilateral cleft nasal deformity: Anthropometry and clinical outcomes

Introduction: The cleft nasal deformity is a three-dimensional asymmetry involving all layers of the nose. Columellar strut graft is an important method to provide support to the skeletal framework in an attempt to retain structural support and balance. Aims: The purpose of our study is to describe the surgical outcomes following the use of columellar strut graft when it is used in secondary cleft rhinoplasty. The study was designed to identify the changes in tip projection (Tip Proj), tip rotation (Tip Rot), and other anthropometric measurements postoperatively. Materials and Methods: A prospective study was conducted among patients presenting with secondary cleft nasal deformity and operated utilizing a columellar strut graft. The parameters considered were columellar height (CH), columellar width, Tip Proj, Tip Rot, nasofrontal angle, nasofacial angle, and nasolabial angle. All the measurements were analyzed statistically. Results: During the study, results could be evaluated for 25 patients. The Tip Proj increased in 84% of patients, and the magnitude of difference between pre- and post-operative follow-up at 9 months was found to be statistically significant (P = 0.009). The CH increased in 20 patients (80%). The Tip Rot increased in 20 patients (80%). The postoperative changes were consistently maintained at different follow-up intervals. Conclusions: Columellar strut is necessary in improving the Tip Proj, correcting the tilted tripod and lower lateral cartilage deformities. It also functions as a central scaffold on which the tip structures can be unified.

Definitive Cleft Rhinoplasty for Unilateral Cleft Nasal Deformity.

tended to be the final surgery for patients with cleft lip and palate. The nasal tip and nostril asymmetries present in patients with unilateral cleft create difficulties for the definitive rhinoplasty. The typical findings contributing to these asymmetries are the retrodisplacement and underprojection of the dome, lateral slumping of the lower lateral cartilage (LLC), shortened columnella, and alar web and hooding. Herein, we present surgical pearls (Video) for performing a sliding chondrocutaneous flap, which incorporates the cleft lip incision, coupled with alar rim incision. Alar base plumping grafts are also often used. This technique can be successfully used as the primary rhinoplasty or as a revision rhinoplasty. In our practice, we perform primary rhinoplasty at the initial time of cleft repair at in patients 1 to 3 months of age and definitive rhinoplasty in teenagers, attempting to eliminate or minimize any intermediate surgical procedures to preserve available grafting material and prevent scarring. The sliding chondrocutaneous flap, or sliding cheilorhinoplasty, borrows tissue from the lip scar to improve projection of the dome and LLC position on the cleft side. The alar rim incision addresses alar and columnella hooding and creates better a contour of the nostril than a marginal incision. Both

3-dimensional anthropometric of outcomes following treatment of unilateral cleft secondary nasal deformity

3-dimensional anthropometric of outcomes following treatment of unilateral cleft secondary nasal deformity

Edge locked stitching between nostril ala and lateral cartilages with a mucochondrial Z-plasty in correction of unilateral cleft nasal deformity in secondary rhinoplasty.

Ala and nostril collapse are most raised complaints in secondary deformity of unilateral cleft patients. While a lot of techniques have been introduced so far, the purpose of this study was to evaluate the effectiveness of edge locked stitching between nostril ala and lateral cartilages with mucochondrial Z-plasty to correct the collapse in lower lateral cartilage in the ala and nostril shaping. Fifty-seven patients with unilateral cleft nasal deformities were recruited. They all had primary surgery before and were left with nasal deformities. Based on the anatomic understanding, we operated on all the patients using edge locked stitching between nostril ala and lateral cartilages with a mucochondrial Z-plasty to correct the abnormal lateral collapse of nostril deformities. All the patients had an improvement in the shape of the ala and nostril immediately after the surgery. Follow-up at 6 months (or later) showed no severe relapse. The edge locked stitching between nostril ala and lateral cartilages with mucochondrial Z-plasty is effective to correct ala and nostril deformities in unilateral cleft.

Secondary Cleft Rhinoplasty

The cleft nasal deformity seen in patients with unilateral and bilateral cleft lip presents a formidable challenge for the facial plastic surgeon. The underlying anatomic deformities combined with scarring from previous procedures make secondary cleft rhinoplasty a difficult procedure for even the most experienced surgeons. Numerous techniques for secondary cleft rhinoplasty have been described in the literature over the past several decades, yet the lack of wide adoption of any given technique highlights the great variability seen with this problem. Regardless, the fundamental goals of achieving nasal symmetry with definition of the nasal base and tip, correction of nasal airway obstruction, and repair of nasal scarring or webbing have driven the progressive evolution of techniques developed to correct various aspects of the cleft nasal deformity. Despite the number of techniques that have been published, very few studies have looked specifically at outcomes in secondary cleft rhinoplasty, and further work is needed in this area. In this article, we will review anatomy of the cleft nasal deformity, repair strategies and timing, surgical techniques for both unilateral and bilateral cleft nasal deformity, and outcomes for secondary cleft rhinoplasty.

Unilateral Cleft Nasal Deformity Correction Using Conchal Cartilage Lily Flower Graft

We present a conchal cartilage lily flower graft for correcting depressed and laterally displaced alar cartilage for correction of unilateral cleft nasal deformity.After making a V incision at the base of the columellar and then marginal incisions, the alar cartilages were exposed. A fusiform-shaped cartilage larger than 2.5 cm in length and 1 cm in width was obtained. The midline long axis was scored with a No. 15 knife, and the lateral one third was split. Two-thirds length portions were folded in half, and they became straightened in the shape of a stalk of a lily flower. Two symmetrical one-third length portions were fanned out bilaterally in the shape of the leaf of a lily flower. The stalk portion was positioned in a pocket between the medial crura, and the 2 leaf portions were placed on the dome of the alar cartilages. The marked points of the cleft side and contralateral side were secured with sutures. The V incision at the base of the columellar and the marginal incisions were closed with a V-Y shape. In this technique, the 2 leaf portions were placed on the dome of the alar cartilages and sutured; therefore, the suture holds the dome of the cleft side to the contralateral side without peaking.Thirteen patients (6 male and 7 female subjects; age range, 13-30 years) were operated. Among them, 6 patients were very satisfied, and 5 patients were satisfied with the results. Two patients felt they were improved.We think the conchal cartilage lily flower graft might be a good method for correction of depressed and laterally displaced alar cartilage in unilateral cleft nasal deformity.

Alar Web in Cleft Lip Nose Deformity

The correction of alar webbing in unilateral cleft lip nose deformity is challenging because of progressive distortions in the alar web region during the period of growth. Alar webbing is a persistent universal deformity in both the primary and secondary cleft lip noses. The purpose of this article is to study the alar web deformity in adult patients with unilateral cleft lip noses. Twenty-five patients aged 13 years and older presenting with unilateral cleft nasal deformity were included. Preoperative and postoperative measurements of the nose, along with detailed intraoperative recording of the deformed anatomy, were done. Preoperative magnetic resonance imaging was also done in selected cases. Transcolumellar open rhinoplasty was performed in all the cases, and nasal septal straightening with centralization was done. Cleft alar base augmentation was done using bone graft to restore symmetry of the nasal tripod. Both the cleft and noncleft alar cartilages were extensively mobilized from the skin and mucosal sides. The overgrown and caudally slumped cleft-side alar cartilage was resected caudally and was then resuspended in a symmetrical position with the noncleft alar cartilage. A midline-strut septal cartilage extension graft was used to restore the tip aesthetics. The skin overlying the alar web was in-rolled after semilunar cartilage resection, and skin excision was also done to restore symmetry with the opposite vestibule. The remaining secondary cleft nasal and lip deformities were corrected depending upon the specific presenting pathologic abnormality. The cleft alar cartilage was found to be caudally displaced in all the cases. The caudal border of the lateral crus was prolapsing in the cavity of the vestibule on the superomedial aspect and was tenting the skin in the area of the weak triangle, producing the characteristic alar web deformity. In the study group, the maximum width of the cleft alar cartilage at the level of the lateral crus was increased by approximately 4 mm when compared with the noncleft alar cartilage. The before- and after-rhinoplasty surgery results were objectively assessed using a patient, surgeon, and independent observer survey. The cosmetic result of the nasal tip complex was found to be very good and good (90%), satisfactory (5%), and poor (5%) in patients. The alar web in unilateral cleft lip nose deformity is the result of caudal overgrowth and migration of the alar cartilage. The caudal edge of the prolapsed lateral crus overhangs the cleft-side nasal aperture on its superomedial aspect, producing this deformity. Satisfactory correction of this deformity should envisage caudal resection and repositioning of the dislocated alar cartilage along with caudal resection of the lateral crus with in-rolling of the skin after resection to achieve symmetric results in unilateral cleft lip rhinoplasty.