“Introducing Preservation Rhinoplasty Principles to Cleft Nasal Surgery: Unveiling the Role of Nasal Ligaments in Infant Anatomy”

Preservation rhinoplasty emphasizes maintaining ligament integrity for stable and natural surgical outcomes. However, its principles have not yet been applied to primary or secondary cleft nasal deformities. In our experience using a modified Tajima (reverse U) incision for cleft nasal reconstruction, we have previously reported unique kinking distortions in the cleft-side lower lateral cartilage (LLC) and distinct soft tissue attachments in abnormal relationship with the dome and crural regions. This raises questions about the role of the Pitanguy ligament—a key structure for nasal stability—in these deformities. During primary lip and nose repair on six infants with cleft lip and palate (three unilateral, three bilateral), we adapted preservation rhinoplasty principles by releasing and repositioning the Pitanguy ligament. This approach alleviated tension on the nasal tip, expanded the skin envelope, and facilitated precise midline alignment of the LLCs through controlled reconstruction of the intercrural and interdomal ligaments. Our findings suggest that preservation rhinoplasty principles, particularly ligament release and reconstruction, may offer functional and aesthetic improvements in cleft nasal surgery. This approach could represent a promising direction for primary and secondary cleft rhinoplasty, focusing on ligament management to achieve balanced and lasting outcomes. Further studies are needed to validate these findings and establish normative references for cleft anatomy.