Application of strut-septum complex stent in nasal tip refinement of secondary unilateral cleft rhinoplasty

Objective To evaluate the clinical efficacy of costal cartilage septal-columellar composite grafts in refining nasal tip aesthetics for secondary unilateral cleft lip nasal deformities, and to provide a reference for clinical treatment. Methods This study has been approved by the institutional medical ethics committee and informed consent was obtained from the patients. A total of 31 patients underwent surgery with a costal cartilage strut-septum complex stent graft. The follow-up period was a minimum of 6 months. Anteroposterior, lateral, and supine photos of the patient were taken before and after the operation. The following measurements were obtained: nasal tip projection (NTP), nasofrontal angle (NFA), nasolabial angle (NLA), nasal tip alar angle (NAA), and nasal tip tangent angle (NTA). Nostril-related indices [nostril area (S), nostril height (h₁), nostril width (w), and nasal sill height (h₂)]) were measured before and after surgery, and cleft/non-cleft side ratios were calculated. Satisfaction with nasal tip aesthetics was investigated using the visual analogue scale (VAS). All measurements were made using preoperative photographs and the most recent follow-up photographs of the patients. Results The follow-up period ranged from 6 to 49 months, with an average of 28 months. All patients underwent healing by first intention. Compared with preoperative measurements, postoperative NTP (preoperative 0.48 <i>vs</i>. postoperative 0.55), NLA (preoperative 83.98&#x00B0; <i>vs</i>. postoperative 100.80&#x00B0;), and NAA (preoperative 160.30&#x00B0; <i>vs</i>. postoperative 168.40&#x00B0;) were significantly increased (<i>P </i>&lt; 0.05). NFA (preoperative 139.20&#x00B0; <i>vs</i>. postoperative 133.50&#x00B0;,<i> P </i>&lt; 0.05) and NTA (preoperative 43.76&#x00B0; <i>vs</i>. postoperative 35.80&#x00B0;, <i>P</i> = 0.062) were decreased. On the cleft versus non-cleft sides, the ratios of S (preoperative 1.10 <i>vs</i>. postoperative 0.94, <i>P </i>&lt; 0.05), w (preoperative 1.10 <i>vs</i>. postoperative 1.02, <i>P</i> = 0.194), h₁ (preoperative 0.71 <i>vs</i>. postoperative 0.90, <i>P </i>&lt; 0.05), and h₂ (preoperative 0.53 <i>vs</i>. postoperative 0.79, <i>P</i> = 0.065) were all near 1. Satisfaction with postoperative results was fairly high. Conclusion The costal cartilage strut-septum complex stent can effectively correct the deflection and collapse of the nasal tip in patients with unilateral cleft lip nose deformity. The postoperative long-term effect is relatively stable.