Ethmoid Perpendicular Plate Grafting: Combined Functional and Subunit Reconstruction in Asian Secondary Cleft Lip-Nose Deformities.

BACKGROUND

Asian secondary cleft rhinoplasty requires robust grafting. Autologous costal cartilage, while common, is limited by donor site morbidity, calcification, and warping. This study introduces a reconstructive protocol using the perpendicular plate of the ethmoid (PPE) to overcome these limitations.

METHODS

A retrospective review included 130 patients who underwent secondary cleft rhinoplasty, with 49 of them using PPE and septal cartilage between September 2017 and August 2025. The surgical technique integrated L-strut reconstruction with soft tissue subunit and orbicularis oris muscle repositioning. A representative subset (n = 12) was evaluated using the NOSE scale and ROE to objectively assess outcomes.

RESULTS

Overall, 98% of patients (48/49) expressed high subjective satisfaction over the follow-up. Complications were rare (2% infection rate, managed conservatively). Quantitative subset analysis demonstrated significant functional and aesthetic improvements: median NOSE scores decreased from 11.00 to 3.50 (p = 0.033), and mean ROE scores surged from 8.17 ± 2.41 to 20.42 ± 4.27 (p < 0.001).

CONCLUSION

Autologous PPE grafting is a reliable, structurally robust alternative to costal cartilage in Asian secondary cleft rhinoplasty. It effectively restores subunit harmony and airway patency with minimal donor site morbidity.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .