Facial plast Surg 2016; 32(02): 213-218
DOI: 10.1055/s-0036-1578567
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Technique in Cleft Rhinoplasty: The Foundation Graft

Holger G. Gassner1, Franziska Schwan1, Frank Haubner1, Gustavo A. Suárez2, Veronika Vielsmeier1
  • 1Division of Facial Plastic Surgery, Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
  • 2Department of Otolaryngology – Head and Neck Surgery, University of Barcelona, Bellvitge University Hospital, Barcelona, Spain
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Publication History

Publication Date:
20 April 2016 (online)


Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip. An advancement flap of vestibular skin is described to correct the vestibular stenosis. A transplant of diced cartilage in fascia is added to augment maxillary soft tissue volume. Subjective and objective measures of form and function are presented in a retrospective series of five cases, illustrating the efficacy of the techniques described.