Two-stage bone grafting for nasal correction in late-presenting patients with unilateral cleft: A 3-year comparative study.

Abstract

We evaluated the long-term impact of a two-stage bone grafting technique on nasal morphology in patients with unilateral cleft lip and palate (UCLP) who missed the optimal timing for alveolar bone grafting. We retrospectively analyzed 148 patients with UCLP (≥12 years) who underwent secondary nasolabial repair between 2018 and 2022. Patients were categorized into three groups: non-grafting repair (n=50), conventional secondary alveolar bone grafting (SABG, n=50), and two-stage bone grafting (n=48). Nasal morphology was assessed using standardized two-dimensional photogrammetry at baseline and at least 3 years postoperatively. At 3 years, the two-stage grafting group exhibited superior outcomes in nasal morphology. In terms of nasal symmetry, the columellar angle improved to a mean of 86.99° (vs. 84.43° in conventional SABG, p<0.05). Key indicators for alar base form also showed improvement: the nasal alar base internal angle was 133.52° (vs. 137.04°, p<0.05) and nasal alar base angle was 1.58° (vs. 2.10°, p<0.05). No significant differences existed between the conventional SABG and non-grafting groups (all p>0.05). Safety was excellent across all the groups. For late-presenting patients with UCLP, two-stage bone grafting offers more effective and lasting correction of secondary nasal deformities than conventional SABG or non-grafting methods.