Background: Late warping of dorsal cartilage onlay grafts is a problematic complication of current secondary rhinoplasty techniques in cleft lip patients. Material and Methods: From May 2005 to December 2008, a total of 282 cleft patients had a secondary rhinoplasty performed at our center with a modified diced cartilage technique. Finely diced cartilage was injected over a cartilage framework, and no "sleeve" was used. Of those patients, 246 with a follow-up of more than 6 months were included in this retrospective study. Results: The infection rate was 7.7%. In addition, 5.7% of patients complained of a bulbous tip. Cartilage warping, as seen with classic en bloc grafting of the dorsum, did not occur. Dorsal irregularity was seen in 8.5% of cases, and grafts were visible in 1.2% of cases. The reoperation rate was 8.1%. Conclusion: This technique has greatly reduced the late cartilage warping seen with the classic cartilage bloc dorsal augmentation. Complications are low, comparable in occurrence to other techniques, and are easily manageable, making it our technique of choice.
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