Long-Term Surgical Outcomes of Intermediate Cleft Rhinoplasty

Background: The risk/benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes our 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion. Methods: We performed a retrospective cohort study of patients who underwent intermediate cleft rhinoplasty from 2006 to 2023. Demographic information and operative details were collected. Primary outcomes were operative complications and need for subsequent rhinoplasty. Results: Three-hundred and forty-two patients undergoing 372 intermediate rhinoplasties were included: 150 (40.3%) with no graft/implant, 165 (44.4%) with iliac crest cartilage graft, 36 (9.7%) with ear cartilage, 19 (5.1%) with a resorbable plate, and 3 (0.8%) with nasal cartilage. Use of iliac crest graft predicted fewer subsequent rhinoplasties independent of age at surgery, age at most recent follow-up, sex, race, syndromic status, cleft severity, intranasal stenting duration, and surgeon (β=-0.234, p =0.012). Employment of a V-Y chondromucosal flap in the unilateral cleft lip group (β=-0.401, p =0.002) and placement of a columellar strut graft in the bilateral cleft lip group (β=-0.450, p =0.028) predicted fewer subsequent rhinoplasties. The proportion of rhinoplasties utilizing iliac crest grafts increased over time (r(372)=0.806, p <0.001). Most (55.0%) patients with follow-up beyond age 18 (n=60) did not require subsequent rhinoplasty. Conclusions: Iliac crest cartilage grafting as a columellar strut in bilateral clefts and a chondromucosal V-Y advancement in unilateral clefts were associated with a decreased need for future rhinoplasty. Further work is needed to understand the risk/benefit ratio, surgical burden, and patient-reported outcomes of intermediate rhinoplasty.