Сохраняющая ринопластика при вторичных деформациях носа у пациентов с врождёнными расщелинами губы и нёба: проспективная серия случаев с оценкой стабильности результатов

Abstract

Congenital cleft lip and palate are accompanied by significant deformities of the external nose, including asymmetry of the alar bases, deformity of the nasal tip, and impaired nasal breathing, which necessitates secondary rhinoplasty. In recent years, preservation rhinoplasty-based on the principle of maximizing the preservation of native anatomical structures-has garnered interest; however, its efficacy and the stability of outcomes in this patient population have not been sufficiently studied. The aim of the study was to evaluate the functional and aesthetic outcomes of preservation rhinoplasty in patients with congenital cleft lip and palate, as well as to analyze the frequency and causes of secondary deformities.
A prospective case series study was conducted, including 50 patients aged 17–25 years with secondary nasal deformities following congenital cleft lip and palate. All patients underwent open-approach conservative rhinoplasty with repositioning and suture fixation of autologous cartilaginous structures without the use of framework grafts. Outcomes were assessed using photometric analysis, anterior active rhinomanometry, and acoustic rhinometry before surgery and 12 months after the procedure.
The data demonstrated a statistically significant improvement in aesthetic parameters (p<0.001), including an increase in the angle of rotation of the nasal tip, improved projection, and a reduction in the degree of alar asymmetry. Functional parameters also improved significantly (p<0.01): total nasal resistance decreased, while airflow volume and the minimum cross-sectional area in the region of the internal nasal valve increased. At the same time, 12 months after surgery, secondary deformities of the external nose were detected in 42% of patients, which was associated with the severity of scarring and insufficient stability of the suture fixation.
Conservative rhinoplasty improves the shape and function of the nose in patients with congenital clefts; however, its application must be tailored: the method is indicated for moderate deformities and minimal scarring, whereas structural techniques with grafts are preferred for severe scar contractures and tissue defects. The results obtained require confirmation in comparative studies.