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

backgroundAsian 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.

methodsA 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.

resultsOverall, 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).

conclusionAutologous 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 .