Comparing definitive unilateral cleft rhinoplasty with and without diced-cartilage alar-base augmentation: A retrospective cohort study

Patients with unilateral cleft deformity have a deficient or hypoplastic maxilla, especially the piriform base and maxillary alveolar arch, while the orbicularis oris shows abnormal insertion into the alar base (An et al., 2021). These result in characteristic faces, including: wide cleft nostril with flat or reverse-curved alar rim; retruded nasal dorsum with depression and malposition of the nasal tip; shortened columella; posterolateral and inferiorly displaced cleft-side alar base; and asymmetric nasal base (Gubisch et al., 1998; Pawar and Wang, 2014; Ayeroff et al., 2019; Talaat et al., 2019; Moore et al., 2020). This deformity draws attention, with negative psychosocial consequences (Gassling et al., 2015; Van Schijndel et al., 2015). Surgical correction improves social experiences, emotional expression, and perceptions regarding appearance and personality (Pitak-Arnnop et al., 2011; Byrne et al., 2014; Posnick et al., 2019).

Unilateral cleft rhinoplasty without alar lift inevitably results in recurrent deformity, with patient dissatisfaction. There are many techniques for producing alar lift. Patient age, nasal patency, and cosmetic concerns influence the timing and choice of management (Lilja, 2009; Pawar and Wang, 2014; Ettinger and Buchman, 2020).

During mixed dentition, secondary alveolar bone grafting (ABG) in the cranial aspect of the maxillary defect can provide maxillary arch stability (Lilja, 2009; Ettinger and Buchman, 2020). It can be used to augment the alar base and improve alar-base symmetry (Lilja, 2009). However, it may worsen nasal aesthetics, and require intermediate rhinoplasty. Due to resorption, the aesthetic results of ABG are equivocal (Gillgras et al., 2014; Kim et al., 2016). Intermediate rhinoplasty with concurrent alveolar bone graft is an emerging option (Kim et al., 2016). However, it does not obviate the need for definitive rhinoplasty. Definitive cheliorhinoplasty with alveolar bone-cartilage graft is an emerging single-stage procedure with favorable long-term outcomes (Zhou et al., 2020) .

Mature deformity, in teenagers and older, is addressed by definitive rhinoplasty with alar-base and peri-alar augmentation (ABPA), which is key to achieving lasting nasal symmetry (Matos et al., 2019; Moore et al., 2020; Liang and Wang, 2021). Materials used include alloplastics, allograft, or autologous tissue. Alloplastics have favorable long-term results, and include silicone, porous polyethylene, expanded polytetrafluorethylene, and injectable calcium hydroxyapatite (Yen et al., 2018; Dong et al., 2021; Rohrich et al., 2021). They are limited by high costs, implant infection, and implant migration. Cadaveric allografts resist warp, but are not widely available (Mohan et al., 2019). ABG performed after canine eruption, fat grafts, and fascial grafts have high rates of resorption (Lilja, 2009; Gillgras et al., 2014). ABG resorption may be mitigated by using cartilage with bone, and by drilling holes into the alveolar bone, facilitating bone marrow mesenchymal stem cell migration and remodeling (Zhou et al., 2020). Diced cartilage has long-term reliability, with low rates of migration and resorption (Brenner et al., 2006; Lin et al., 2016; Bashir et al., 2017; Dong et al., 2021; Ledo et al., 2021; Liang and Wang, 2021). Current techniques for diced cartilage ABPA need refinement (Farouk and Ibrahiem, 2015; Matos et al., 2019; Zhou et al., 2020; Moore et al., 2020; An et al., 2021; Liang and Wang, 2021). The impact of diced cartilage alar lift on definitive rhinoplasty outcomes is yet to be described through a comparative study.

Our study aimed to measure long-term aesthetic outcomes and patient satisfaction following definitive secondary rhinoplasty with diced-cartilage ABPA in unilateral cleft patients who presented with mature deformity, most of whom had not undergone prior ABG, against a control group.

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