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

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The Cleft Palate-Craniofacial Journal 56(1)

Two review authors extracted data independently. The follow ing details were recorded when available:

new techniques, modifications, or personal protocols and expe rience. Some of the papers reported on combined cohorts of unilateral and bilateral and primary and secondary rhinoplasty, and it was not possible to extract data separately in these cases. Although long-term follow-up was one of the inclusion criter ion, due to lack of adequate studies, we had to include studies with short-term follow-up also. Quality assessment of the included studies is presented in Table 1. We identified 5 case series on open rhinoplasty (Table 2) and 8 on closed technique (Table 3), 2 retrospective cohorts comparing open and closed techniques (Table 4), and a single RCT. Presence of multiple cointerventions in addition to the inter vention of interest like presurgical orthopedics, postoperative splinting, and variations in techniques used for rhinoplasty and assessment of outcome makes attempts at comparing the data of questionable validity. There was only 1 RCT comparing open and closed tech niques. This study has concluded that both techniques give similar results after a short follow-up evaluation at 6 months. The retrospective comparative studies had done assess ments subjectively and objectively using definite parameters, though there is no uniformity between the studies on these parameters. The first one has concluded that there is no dif ference between the 2 techniques but is in favor of the closed technique as they found more “difficult to correct complications” following their open approach. The second comparative study has demonstrated better results with the semiopen technique using Tajima incision. The closed technique series have all shown improved sym metry of nostrils with follow-up, so that secondary surgery will be less extensive. No interference with growth has been found. The completely open technique is being done by fewer sur geons. The studies included have shown good long-term results and have reported reduced number of secondary surgeries, and when required the intervention to be of much smaller magnitude. All the reports demonstrate the advantages of a primary cleft rhinoplasty. It is interesting to note that nasal overcorrection with Tajima, which has been carried out in many of the studies, appears to maintain nostril height long term. Discussion This systematic review of published outcomes of closed and open rhinoplasty techniques yielded 3 comparative studies, of which 1 was an RCT and other 2 retrospective cohort studies, and 13 case series, of which 5 were open and 8 closed methods. Marimuthu et al. (2013) conducted a single-center RCT comparing closed to open technique of rhinoplasty with pri mary cleft lip repair in unilateral cleft cases involving 36 patients. The age range of patients was 2 to 45 years and follow-up assessment could be done only in 16, with 8 in each group. A statistically significant outcome was found only in one of the 3 measurements used for quantitative analysis—the alar base width in favor of open technique (Table 5). This study

1. Trial methods: method of randomization, allocation, sample size, blinding methods, and losses at follow-up. 2. Participants: country of origin, year of study, setting sample size, age, and inclusion and exclusion criteria. 3. Intervention: technique used, details of the method, time of follow-up. 4. Control: surgical technique used and details of method. 5. Outcomes: Method of assessment of the outcomes, sta tistical analysis. Dealing With Missing Data In studies where data were unclear or missing, we contacted the principle investigator by e-mail. Data Synthesis Assessment of risk of bias. The assessment of the risks of bias was done using Cochrane’s tool for assessing risk of bias as described in section 8.5 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green, 2011). Two reviewers inde pendently carried out the assessment and any disagreements were resolved through discussion with the third reviewer. Assessment of risk of bias carried out for the RCT is as follows: Sequence generation. Randomization has been carried out using the sealed envelope technique. This has been evaluated as low risk of bias. Allocation. Allocation concealment was not reported in the article. E-mail communication with the corresponding author confirmed it was carried out—low risk of bias. Blinding. Blinding of personnel to the intervention is probably not completely feasible in this study. E-mail communications revealed that patients and assessor were blinded—there is low risk of detection bias, but overall evaluated as unclear risk of bias. Incomplete outcomes data. The study reports 20 cases lost to follow-up. Hence, the study is evaluated to have a high risk of bias. Selective outcome reporting. There is no study protocol avail able in the publication. E-mail communication confirmed that there is designed protocol regarding parameters and follow-up. Hence, the study is considered to have unclear risk of bias. Other bias. As a study protocol is not published, it is difficult to assess other potential bias in the study. Hence, judged as unclear risk of bias. Results The study selection PRISMA flow diagram is given in Figure 1. There is a paucity of controlled trials on this procedure. Most of the publications on cleft rhinoplasty are narrative regarding