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

Overcorrection of 20% maintains nostril height long term

Minor variations and secondary deformities are less difficult to correct during secondary surgery if indicated

Excellent postoperative results and does not entail any more trauma to nasal cartilage complex

Very good results with limited open approach. No intermediate rhinoplasty

required. 40% do not require definitive rhinoplasty

Early results superior to closed technique; Need for secondary surgery will be reduced in number and magnitude of intervention

Period Details of Procedure Assessment Method Outcome Conclusion

Best outcome for group IV based on measurements and panel assessment. Group IV had the most symmetrical nose in

terms of height, width, nasal

web, nasal sill, nostril area, and nostril shape.

0.72 with standard deviation of 0.42. Less satisfactory score

Khoula Hospital, Muscat 1994-2007 255 (complete) 3 months 14 years Harashina’s open rhinoplasty. Rim incisions; septum— dislocation done Evaluation with photographs Better projection of nostril tip as closed technique does not allow intercrural soft tissue dissection Hospital, Maulana Azad Medical College, New Delhi, India and 6 incomplete cleft of lip) Mean 6 months (4-36 months) Mean 18 months (4 months to 4.5 years)

Excellent 20%; very good 48.5%; good 25.8%; fair 5.7%

Anatomical repositioning of alar cartilages maintained

Score for nasal symmetry was

Photographic (2-D) evaluation by blinded independent observer on measurement of nostrils height, width, area, sill

heightened fourth medial part

nostril height, height to width

ratio, and panel assessment by Visual Analog Scale

Patient direct evaluation by surgeon and peer. 6 parameters—1 for nostril symmetry. 4 scales based

on noncleft as 0. Mild, moderate, and severe deviations as 1, 2, and 3

Analysis by colleagues on—alar elevation, tip reconstitution, nostril shape and symmetry,

columellar height, and web in vestibule/soft triangle

Photographic documentation and evaluation

1992-2003 76 (all complete) 3 months 5 years Group I—Rim incision and no NAM Gr II—NAM. No rhinoplasty Gr III—NAM þ B/L rim incisions Gr IV—NAM þ Tajima on cleft side, rim incision noncleft side þ overcorrection (splint overcorrection also) complete, 50 3-4 months, 4-6months

– Bilateral alar rim incisions— slightly higher on cleft side. Absorbable transfixing sutures to realign

Limited open rhinoplasty— Tajima on cleft and rim on noncleft. Realign alar

cartilage with single stitch; septum—not done

Hospital Besar, Alor Setar, Malaysia 1991-1993 15 cases 6 months to 16 years (8 cases before 1 year) 6months Harashina open rhinoplasty technique; septum—not done

Follow-Up

(if presurgical

orthopedics)

AgeDuring

Intervention

incomplete)

Number of Patients

2002-2010 122 (72

Study

Period

1999-2004 35 (29 complete

Table 2. Open Rhinoplasty Case Series. Study Study Location Chang et al. (2010) Chang Gung Memorial Hospital, Taiwan

Center, Khon Kaen

University, Thailand

Tawanchai

Chowchuen et al. (2010)

(2009)

Trott and Mohan

(1993)

Thomas

Ahuja (2006) Lok Nayak

Abbreviation: NAM, nasoalveolar molding.

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