Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes

Background: The intermediate cleft tip rhinoplasty (ICTR) is performed in childhood to address residual tip asymmetries during the most critical period of psychosocial development. We describe and evaluate long-term outcomes of an ICTR approach for the unilateral cleft lip and palate (UCLCP) patient based on the concept of individual restoration of each abnormal anatomical component. Methods: Photomorphometric analyses of UCLCP patients (n=50) who underwent ICTR using the component restoration technique were evaluated preoperatively (t0) and postoperatively at 3 years (t3) and compared to age-matched UCLCP control patients. Nasal relationships (alar symmetry, nasal tip protrusion to alar base width ratio, and height to width dimensions for the cleft and non-cleft nostril) were compared over time using a linear mixed-effect model. Results: At t0, both groups demonstrated similar nasal relationships with the exception of a wider cleft-side nostril in relationship to height in the ICTR group. The component restoration ICTR technique improved all four nasal relationships at all postoperative timepoints compared to t0 in a statistically significant manner, whereas control UCLCP patients did not demonstrate significant changes at the corresponding ages. Long-term differences at t3 revealed a trend towards improved alar symmetry, cleft-side and non-cleft-side nostril dimensions and a significant improvement in the nasal tip protrusion to alar base width ratio in ICTR-treated versus control patients (p=0.002). Conclusions: The component restoration technique for the unilateral ICTR improves nasal relationships towards normal immediately and in a sustained manner for at least three years. Presented at the 96thAnnual Meeting of the American Association of Plastic Surgeons, March 25-28, 2017, Austin, Texas Disclosures: All authors have no financial interests including products, devices, or drugs associated with this manuscript. There are no commercial associations that might pose or create a conflict of interest with information presented in this submitted manuscript such as consultancies, stock ownership, or patent licensing arrangements. All sources of funds supporting the completion of this manuscript are under the auspices of the University of California Los Angeles. Acknowledgments: We wish to acknowledge Dr. Johnny Lin, PhD from the UCLA Institute for Digital Research and Education for his expert assistance with the statistical analyses. This work was supported by the Bernard G. Sarnat Endowment for Craniofacial Biology (JCL). JCL is additionally supported by the Jean Perkins Foundation and the US Department of Veterans Affairs under award number IK2 BX002442-01A2. Corresponding Author: Justine C. Lee, MD, PhD, FACS, University of California Los Angeles, Division of Plastic and Reconstructive Surgery, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, Phone (310) 794-7616, Fax (310) 206-6833, justine@ucla.edu ©2018American Society of Plastic Surgeons

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