From Hip to Tip: Harvesting Iliac Crest Cartilage for Delayed Cleft Rhinoplasty

Abstract

Objective

This study evaluates nasal symmetry outcomes in patients with unilateral cleft lip (UCL) who underwent delayed rhinoplasty during iliac bone grafting (IBG), allowing concurrent bone grafting and cartilage harvesting to reduce donor sites.

Design

Retrospective cohort study.

Setting

Tertiary care pediatric hospital.

Patients

Those with UCL who underwent IBG and primary rhinoplasty during the same operation.

Interventions

Primary rhinoplasty at the time of IBG.

Main outcome measures

Cephalometric analyses of pre- and postoperative basilar view nasal images assessed nostril height, nostril width, nasal circumference, and angle of columellar deviation.

Results

The final cohort included 52 patients with a mean age of 7.61 years (range 5.51-13.7) at the time of concurrent IBG and delayed rhinoplasty, with a mean follow-up of 4.6 years (range 1.02-15.1). Cephalometric measurements were evaluated by the ratio of the shorter or smaller side to the longer or larger side. Average preoperative nostril height was 0.70 (range 0.23-0.95) which increased postoperatively to 1.0 (range 0.60-8.35) (P = 0.047). Average preoperative circumference was 1.27 (range 0.67-2.01) which decreased to 1.12 (range 0.70-1.68) postoperatively (P = 0.011). The angle of columellar deviation averaged 8.0 degrees (range 1.57-18.7) preoperatively which decreased to 6.0 degrees (range 0.22-18.4) postoperatively (P = 0.010).

Conclusions

Delaying primary rhinoplasty until the time of IBG yields satisfactory outcomes, with iliac crest cartilage providing favorable, longlasting results in patients with UCL. This approach reduces the need for an additional donor site and may reduce the need for subsequent definitive rhinoplasty.