34. Bioresorbable Plates as an Alternative for Columellar Support in Secondary Cleft Rhinoplasty

PURPOSE: The cleft nasal deformity presents a unique set of functional and aesthetic challenges. Complex congenital nasal anatomy, deformed cartilages, scarring from prior operations, and growth-related changes contribute to the challenges of the secondary cleft rhinoplasty. Lack of nasal tip projection is a common patient complaint; therefore, columellar support is invariably addressed during the operation. Traditional surgical methods that include autologous cartilage grafts are associated with donor site morbidity, limited graft availability, and uncertainty of resorption mechanics. In addition, depending on the cartilage source, grafts may not always provide the degree of structural support required to gain adequate nasal projection. Bioresorbable plates are a safe, reliable alternative to autografts that provide strong support without the morbidity of cartilage harvesting. We describe a single center’s experience using the Resorb-X® bioresorbable plate in secondary rhinoplasty in patients with unilateral and bilateral cleft lip nasal deformities with poor tip projection, requiring columellar support. METHODS: A retrospective chart review identified patients with cleft deformities that underwent an open rhinoplasty from 2007-2022. Patients were screened for open rhinoplasty with the use of a bioresorbable plate (BRP) or cartilage graft only (CG) for columellar support. A bivariate analysis was conducted to compare baseline patient characteristics between the two groups. Data collected included cleft type, age at time of surgery, sex, race, date of last follow-up, complications, and need for revision surgery. RESULTS: In total, 63 patients who underwent secondary cleft rhinoplasty were evaluated. From this sample, 30 patients underwent rhinoplasty with the use of a bioresorbable plate and 33 had a cartilage graft. Patients with bilateral clefts comprised 40.1% of the BRP group and 12.5% of the CG group. Average age at time of surgery was 18.1 years in the BRP group, and 19.5 years in the CG group. Females comprised 56.6% of the BRP group and 54.4% of the CG group. Most of the sample population identified as white, with 76.7% in the BRP group and 78.8% in the CG group. Average duration of follow-up was 834.9 days (2.3 years) in those with a bioresorbable plate versus 398.1 days (1.1 years) in those with a cartilage graft. Complications in the BRP group included infection (n=2), extrusion (n=1), and deformation (n=1). Complications in the CG group included deformation (n=1) and perforation (n=1) (p=0.25). Revision rhinoplasties were conducted in 4 patients in the BRP group and in 2 patients in the CG group (p=0.23). Initial review of long-term postoperative results demonstrated maintenance of tip projection and excellent aesthetics in patients that underwent columellar extension support with a bioresorbable plate. Cases will be discussed. CONCLUSION: Bioresorbable plates are a clear alternative to cartilage grafts for columellar support in the challenging secondary cleft rhinoplasty repair, especially in a patient population where the harvest morbidity is not acceptable. These provide rigid nasal tip projection without the need for a second autologous cartilage donor site. Postoperative aesthetic results were excellent in the long-term, as nasal tip projection appeared to remain stable despite material resorption mechanics.