Resorbable plate as a novel method for tip derotation in intermediate rhinoplasty for bilateral cleft lip nasal deformity.

Abstract

Bilateral complete cleft lip and nasal deformity are characterized by a flattened nasal tip, splayed nostrils, and a shortened columella. Efforts to improve nasal tip projection during intermediate rhinoplasty may inadvertently induce cephalic rotation. We selectively applied a resorbable plate secured to the nasal dorsum in a derotation configuration for patients with a preoperative nasal tip angle ≥120° and evaluated its effect on postoperative cephalic rotation of the nasal tip. A retrospective analysis was performed in 15 patients with bilateral complete cleft lip nasal deformity who underwent intermediate rhinoplasty. Patients were divided into a plate group (n=10) and no-plate group (n=5) according to the preoperative nasal tip angle. Standardized pre- and postoperative two-dimensional photographs obtained 1-2 years postoperatively were analyzed using angular and proportional measurements. Postoperative outcomes were compared with age- and sex-matched normal controls. The reduction in nasal tip angle was greater in the plate group than in the no-plate group. The nasal dorsum angle increased significantly in the plate group, and the preoperative difference between the groups was no longer present postoperatively. The columellar-labial angle decreased significantly only in the plate group. Columellar lengthening parameters improved in both groups, with the changes being more pronounced in the plate group. The nasal tip height ratio increased slightly in both groups. Selective insertion of a resorbable plate in a derotation configuration during intermediate rhinoplasty was associated with improved nasal tip projection while limiting excessive cephalic rotation in growing patients with bilateral complete cleft lip nasal deformity.