title: Alveolar bone grafting with simultaneous cleft lip rhinoplasty.
abstract: BACKGROUND
  Optimal timing for cleft lip rhinoplasty is controversial. Definitive rhinoplasty is deferred until facial skeletal growth is completed. Intermediate rhinoplasty is performed after stabilization of the grafted alveolar bone, because the grafted bone tends to be absorbed over several months postoperatively, distorting the nasal profile. Here, we report our experience with simultaneous rhinoplasty during alveolar bone grafting for indicated patients, describe our surgical technique that ensures long-term bone graft survival, and report graft take rates and nasal profile changes.
  
  
  METHODS
  This retrospective chart review included a total of 54 patients; 44 underwent alveolar bone grafting only, and 10 underwent simultaneous cleft lip rhinoplasty. All surgeries were conducted with a judicious mucosal incision for tensionless wound closure. Bone graft take was evaluated with dental radiographs by the Bergland classification. Further, nasal aesthetic outcome was evaluated with medical photographs, based on nostril height and width and alar base width.
  
  
  RESULTS
  In total, 96.3% of clefts showed graft success with Type I (66.7%) or Type II (27.8%) classifications; only 3.7% of clefts showed unfavorable results classified as Type III, and no clefts showed Type IV failure. The nasal shape was flatter with a decreased nostril height and increased nostril width after alveolar bone grafting, while nostril height was increased and nostril width was decreased in patients who underwent simultaneous rhinoplasty.
  
  
  CONCLUSIONS
  With surgical techniques ensuring alveolar bone graft survival, simultaneous cleft lip rhinoplasty can result in nasal aesthetic improvement for patients with severe nasal deformities, decreasing the number of operations.
authors: Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Young-Eun
authors: YE
authors: Kim
authors: Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jihyeon
authors: J
authors: Han
authors: Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Rong-Min
authors: RM
authors: Baek
authors: Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: plasrecon@gmail.com.
authors: Baek-Kyu
authors: BK
authors: Kim
mesh_terms: D000293:Adolescent; D064728:Alveolar Bone Grafting; D000543:Alveoloplasty / Q000379:methods; D016025:Bone Transplantation; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010780:Photogrammetry; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
keywords: Alveolar cleft; Alveoloplasty; Cleft lip rhinoplasty; Iliac bone graft