A Novel Approach to Intermediate Cleft Rhinoplasty Utilizing a Pedicled Fibrofatty Flap

Summary: Patients with cleft lip ± palate may experience psychosocial issues related to their secondary cleft nasal deformities. These concerns can be addressed earlier instead of being required to wait until skeletal maturity. A novel early rhinoplasty intervention utilizing a dorsal fibrofatty pedicled flap is performed by the senior author to address nasal aesthetics in patients with secondary nasal deformities. This study aimed to describe this novel intermediate rhinoplasty technique and to evaluate improvement of nasal aesthetics. A retrospective review of patients with unilateral and bilateral cleft lip who underwent open rhinoplasty by a single surgeon at less than 10 years old from 2008 to 2023 was conducted. To evaluate aesthetic improvement, preoperative and postoperative photographs of patients were graded by 2 reviewers utilizing the Asher-McDade Aesthetic Index. Paired t tests compared preoperative and postoperative Asher-McDade Aesthetic Index nasal form and nasal deviation scores. A total of 43 patients underwent early rhinoplasty utilizing this technique at an average age of 5.5 ± 1.1 years. Compared with preoperative photographs, postoperative photographs of patients demonstrated a significant improvement in nasal form ( P < 0.001) and nasal deviation ( P < 0.001). No intraoperative or postoperative complications were reported. Only 1 (2.3%) patient underwent revisional surgery. Long-term follow-up will assess the finalized revision rate. This technique is a safe and valuable tool in patients who benefit from earlier treatment of secondary cleft nasal deformities due to significant asymmetry and psychosocial concerns.