Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec 24.
doi: 10.1097/SCS.0000000000012351. Online ahead of print.

Photomorphometric Analysis-based Surgical Outcomes in Intermediate Cleft Rhinoplasties: An 18-Year Experience

Liana Cheung  1 , Allison C Hu, Jinggang Ng, Ben Massenburg, Daniel Y Cho, Jordan W Swanson, Oksana Jackson, David W Low, Jesse A Taylor
Affiliations

Photomorphometric Analysis-based Surgical Outcomes in Intermediate Cleft Rhinoplasties: An 18-Year Experience

Liana Cheung et al. J Craniofac Surg. .

Abstract

Background: Intermediate cleft rhinoplasty (ICR) addresses nasal deformities in children with cleft lip and/or palate (CL/P), yet the influence of surgical planning and outcomes remains underdefined. This study evaluates decision-making and postoperative outcomes using quantitative photomorphometric analysis (PMM), with emphasis on graft selection, positioning, and suture techniques in unilateral and bilateral cleft nasal deformities.

Methods: A retrospective review was performed of all nonsyndromic children with cleft lip and/or palate (CL/P) who underwent ICR between 2006 and 2023. Operative data included concomitant procedures, graft type, positioning, and suture method. PMM was based on standardized basal, frontal, and lateral photographs quantified nasal symmetry and projection.

Results: Of 317 patients, 128 had adequate photography for PMM. In patients with unilateral clefts, greater preoperative asymmetry and poor projection were predictive of cartilage grafting, with iliac cartilage being the preferred choice. Immediate postoperative PMM showed significant improvements in symmetry and protrusion across most techniques (P<0.01), especially with iliac cartilage and cleft-side alar batten grafts. Interdomal sutures significantly enhanced projection. In bilateral cleft cases, graft choice was less predictable, but less severe asymmetry correlated with tip onlay graft use. The modified Potter V-Y advancement flap improved symmetry and projection. At skeletal maturity, unilateral patients with iliac cartilage grafts required fewer secondary rhinoplasties (P=0.0024). No significant donor site morbidity was observed.

Conclusions: ICR offers significant immediate improvements in nasal symmetry and protrusion when aligned with preoperative severity. Iliac crest cartilage grafting yields consistent and durable results in unilateral cleft rhinoplasty, and may be worthwhile when concomitant to planned alveolar bone grafting.

Keywords: Bone grafting; cleft lip and palate; rhinoplasty.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Massenburg BB, Mercan E, Ettinger RE, et al. The Yin and Yang of primary unilateral cleft lip and nose repair: balance through opposing cleft and noncleft side changes. Plast Reconstr Surg 2023;151:838e–849e
    1. Tse RW, Ettinger RE, Sitzman TJ, et al. Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: a data-driven model and its implications. J Plast Reconstr Aesthet Surg 2021;74:2694–2704
    1. Tse RW, Knight R, Oestreich M, et al. Unilateral cleft lip nasal deformity: three-dimensional analysis of the primary deformity and longitudinal changes following primary correction of the nasal foundation. Plast Reconstr Surg 2020;145:185–199
    1. Mulliken JB. Bilateral complete cleft lip and nasal deformity: an anthropometric analysis of staged to synchronous repair. Plast Reconstr Surg 1995;96:9–23; discussion 24–6
    1. Mulliken JB. Repair of bilateral complete cleft lip and nasal deformity--state of the art. Cleft Palate Craniofac J 2000;37:342–347

LinkOut - more resources