xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Original Article

The Cleft Palate-Craniofacial Journal 2019, Vol. 56(1) 74-83 ª 2018, American Cleft Palate

Outcomes of Closed Versus Open Technique of Rhinoplasty During Primary Repair of Unilateral Cleft Lip: A Systematic Review

Craniofacial Association Article reuse guidelines:

sagepub.com/journals-permissions DOI: 10.1177/1055665618787689 journals.sagepub.com/home/cpc

Rajshree Jayarajan, MCh, FEBOPRAS 1 , Anantharajan Natarajan, MRCS, MCh 2 , and Ravindranathan Nagamuttu, MBBS, FRCS 2

Abstract Objective: Primary cleft rhinoplasty has almost become the norm in cleft practice. Although various closed and open rhinoplasty techniques are in use, there is no consensus as to which technique is superior in terms of outcome. The authors hypothesized that the long-term outcomes of open rhinoplasty during primary cleft lip repair in unilateral cleft is better than that of the closed method. This systematic review has been done to evaluate the hypothesis by a review and analysis of literature. Methods: Protocol was registered on the PROSPERO register of systematic reviews. PRISMA-P guidelines for the conduct of systematic review were followed. Literature search was done in various databases. The inclusion criteria were patients with nonsyndromic unilateral cleft lip undergoing rhinoplasty with primary cleft lip repair and preference given to studies comparing the 2 procedures. Results: Sixteen articles were selected based on inclusion criteria after screening 522 articles—1 randomized controlled trial, 2 retrospective cohorts, and 13 case series. Both closed and open techniques have achieved good symmetry of nostrils with no impairment of growth. No advantage of one technique over the other was noted. Conclusions: There is a paucity of randomized controlled trials and prospective studies on the subject to arrive at an evidence based recommendation as to whether open or closed rhinoplasty during primary cleft lip repair gives better long-term outcomes. Due to insufficient evidence, the authors are not able to support or refute the hypothesis put forward in the review.

Keywords rhinoplasty, surgical technique, nose, nonsyndromic clefting

interference with nasal growth and the correction of alar carti lages and nasal tip was maintained. Anthropometric measure ment showed no difference between patients who had undergone primary rhinoplasty and normal children at 3 years in a series by Kim et al. (2004). This study also showed better symmetry of nostril and nasal dome projection in children who had primary rhinoplasty. In a retrospective assessment of long 1 Department of Plastic Surgery, University Hospitals of Leicester, Leicester, United Kingdom 2 Maxillofacial, Facial Plastic and Reconstructive Surgery, Pantai Jerudong Medical Centre, Brunei Darussalam Corresponding Author: Rajshree Jayarajan, MCh, FEBOPRAS, Department of Plastic Surgery, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom. Email: rajshreecj@gmail.com

Introduction Cleft lip and palate is one of the most common congenital defects with an overall prevalence of 1 in 700 live births world wide (Ahmed et al., 2017). Correction of the cleft nasal defor mity is almost an integral part of primary repair of the cleft lip since it has been proved that early surgery on the cartilage does not have a detrimental effect on growth (Salyer, 1986; McComb and Coghlan, 1996). Blair and Brown were the initia tors of primary nasal correction with lip surgery (Millard, 1976). This concept was popularized by McComb (1985) and Salyer (1986). As Millard and Morovic (1998) had noted, uni lateral cleft lip repair without nasal correction condemns the child to a childhood burdened by this deformity. A 10-year follow-up of children who had undergone primary cleft rhino plasty by McComb (1985) and after completion of this study 18 years later (McComb and Coghlan, 1996) demonstrated no