Median cleft nasal deformity is traditionally described as a disorder of midline development, encompassing varying degrees of tissue deficiency, malposition, and excess. However, intraoperative findings in the present series suggest that, in selected patients, the cartilaginous framework is present but structurally disorganized rather than absent, with implications for surgical strategy.

Three patients with median cleft nasal deformity within the frontonasal dysplasia spectrum underwent reconstruction between 9 and 12 months of age using a technique based on mobilization, reorientation, and centralization of native cartilaginous structures. Follow-up ranged from 3.5 to 5 years (mean, 4.3 years).

All patients demonstrated improved midline alignment and dorsal projection, with maintained framework alignment during follow-up, although dorsal projection remained modest relative to age-matched norms. No clinically evident loss of projection or recurrent cartilaginous divergence was observed during available follow-up. Outcomes were achieved without the use of cartilage grafting.

Median cleft nasal deformity, in selected cases, appears to reflect disorganization of an existing cartilaginous framework rather than true deficiency. Early reconstruction by centralization of native structures may help restore a coherent framework within a staged treatment approach. These observations are preliminary and require confirmation in larger series with objective assessment and longer follow-up.