Intraoperative Analysis of Unilateral Cleft Lip Nasal Deformity: Assessment of the Lower Lateral Cartilage Following Correction of the Nasal Foundation and Nasal Tip Dissection Via a Modified Tajima Incision

Background: Achieving consistent correction of unilateral cleft lip nasal deformity (uCLND) remains challenging due to the complex interplay between skeletal, soft tissue, and cartilaginous components. This study evaluates intraoperative lower lateral cartilage (LLC) distortions, their distribution, and their associations with cleft characteristics and presurgical infant orthopedics (PSIO), using the modified Tajima incision for direct visualization. Methods: Fifty patients undergoing unilateral cleft lip repair with foundation-based primary rhinoplasty were analyzed. Intraoperative LLC distortions were classified based on location (dome, medial crus, lateral crus, or combined) and severity (significant or non-significant). Correlations were assessed with cleft type, PSIO use, and pre-Tajima nasal morphology. Results: LLC distortions were observed in 80% of patients; 45% of these were significant. Dome involvement was most common (60%), especially in incomplete clefts, while combined deformities predominated in complete clefts. Severity was associated with cleft type ( P =0.0045), and location was linked to both severity ( P <0.001) and laterality ( P =0.012). Before tip dissection, unfavorable nostril shape on the non-cleft side appeared in 85.7% of CLA and 80.0% of CLP cases, correlating with cleft type ( P <0.001) and location of distortion ( P =0.0014). Affected-side morphology predicted both anatomic location ( P <0.000001) and severity ( P =0.014) of the distortion. PSIO use showed an inverse correlation with the frequency of significant cases (ρ=–0.80). Conclusions: Intraoperative assessment via the modified Tajima incision revealed consistent LLC distortion patterns linked to cleft severity, nasal morphology, and PSIO use.