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Long Term Outcomes of the Intermediate Cleft Tip Rhinoplasty
Rachel S. Mandelbaum, BA1, Elizabeth J. Volpicelli, BA1, Miles J. Pfaff, MD1, James P. Bradley, MD2, Justine C. Lee, MD, PhD1.
1University of California Los Angeles, Los Angeles, CA, USA, 2Temple University, Philadelphia, PA, USA.

PURPOSE: Intermediate tip rhinoplasty in the cleft patient is performed in late childhood to improve symmetry of the lower lateral cartilages. In this work, we review the utility and longevity of intermediate correction using photographic measurements.
METHODS: Anthropometric nasal configurations in photos of 24 patients with complete cleft lip and palate who underwent tip rhinoplasty with conchal skin/cartilage composite grafts at the UCLA Craniofacial Clinic between 2004-2013 were reviewed. Preoperative and postoperative (5 years) measurements were compared using two-tailed paired t-tests.
RESULTS: The average age at tip rhinoplasty was 11.4 years. Nasal symmetry, assessed by the ratio between the distances from nasal tip to alar base on the cleft versus non-cleft side, was improved from 0.92 preoperatively to 0.97 immediately postoperatively (p=.005). However, in follow up beyond one year, improvement in nasal symmetry was no longer significant. Nasal projection, measured by the nasal base width divided by the height from columnar base to tip, was improved by 11.69% after tip rhinoplasty (p=.012), and results remained statistically significant at follow up to >5 years. Facial symmetry, estimated by the ratio between the distances from the medial canthus to the alar base on the cleft versus non-cleft side, improved from 0.95 preoperatively to 0.97 immediately postoperatively (p=.039) and to 0.98 at 1-5 years follow up (p=.002). However, the difference was not significant at 5 years or more after surgery (p=.340).
CONCLUSION: Tip rhinoplasty for cleft nasal deformities in late childhood resulted in immediate improvement of symmetry and projection.


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