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The Cleft Palate-Craniofacial Journal 56(1)

Table 4. Comparative Retrospective Studies.

Criteria

Yasonov et al. (2016)

Lu et al. (2012)

Number of patients Mean age of patients

60 (closed 29, open 31)

66 (closed 21, semiopen 1-25, semiopen 2-20)

3months

Closed rhinoplasty technique Mc Comb and Coghlan

Limited nasal dissection through lip incision

Open rhinoplasty technique Vissarionov

Semiopen 1: cartilage dissection and repositioning through bilateral rim incisions. Semiopen 2: cartilage dissection and repositioning through Tajima incision on cleft side and rim incision on noncleft side 1.Measurements by single observer using digital analysis software—6 parameters 2.Panel assessment using Visual Analog Scale Open method especially using the Tajima incision showed better results in terms of nostril height and nostril axis which were statistically significant 5-6 years (retrospective) Applied (ANOVA test)

Mean follow-up period Analysis of outcome

10 years (retrospective)

1. Subjective information from respondents 2. Objective scales based on evaluation of 5 parameters Subjective and objective analysis did not reveal statistical difference between open and closed method of rhinoplasty Applied (Fisher method and w 2 )

Statistical analysis

Conclusions

Abbreviation: ANOVA, analysis of variance.

Table 5. Randomized Controlled Trial Analysis. a

Parameters Assessed

Closed Rhinoplasty Open Rhinoplasty

P Value Comments

2.48 + 1.29

2.1 + 1.53 .593 Statistically not significant

Nostril height deference between cleft and noncleft side (mm) Alar base width difference between cleft and noncleft (mm) Columella length difference between cleft and noncleft (mm) Nostril orientation—symmetrical Nostril orientation—asymmetrical

5.56 + 2.47

2.7 + 2.72 .046 Statistically significant difference between the closed and open rhinoplasty group in favor of open rhinoplasty

2.07 + 1.16

1.47 + 0.9

.271 Statistically not significant

62.5% 37.5% 62.5% 37.5%

50% 50%

Columella deviation—present Columella deviation—absent

37.5% 62.5%

a Marimuthu et al. (2013): Patient or population: Nonsyndromic unilateral cleft lip patients; Setting: Bhagwan Mahaveer Jain Hospital, Smile Train Unit, Bangalore, India; Study Period: January 1, 2007 to January 31, 2008; Age of patients: 2 to 45 years; Follow-up period: 6 months; Intervention: Open rhinoplasty with primary lip repair; Comparison: Closed rhinoplasty with primary lip repair.

has concluded that both techniques give similar results. The deficiencies in this study such as small sample size, wide age-group of samples, loss to follow-up, short follow-up dura tion (6 months), and classification as unclear risk of bias make this conclusion unreliable evidence to guide clinical decision making. Of the 2 retrospective cohort studies, Yasonov et al. (2016) conducted a 10-year period retrospective study of 60 patients and subjective and objective assessment showed no statisti cally significant difference between the 2 methods. In their evaluation of complications, they found the number of “difficult to correct” complications to be more in the open rhinoplasty group and anticipate that this would complicate secondary rhinoplasty. In view of this, they consider closed rhinoplasty better as there is less damage to alar cartilages and no scars. Lu et al. (2012) have done a comparative study in 66 patients between closed and 2 types of open incisions—one with bilateral rim incisions and other with rim incision on noncleft and Tajima

with rim incision and overcorrection on cleft side. This 5- to 6-year retrospective study on patients with incomplete cleft lip has reported statistically better outcomes for the overcorrected group in terms of nostril height and axis compared with the closed method and also with the rim incision-only group. All the patients benefitted from primary rhinoplasty. A retrospective series of 26 cases of McComb rhinoplasty on 3- to 12-month old primary lip repair with a follow-up of 6 months to 2 years by Spencer and Buzzo (2017) reports results as optimal or satisfactory regarding symmetry between nostrils and columella position on being assessed by 5 plastic surgeons using photographs. Tang et al. (2016) have used preoperative nasoalveolar mold ing (NAM) and Tajima incision for correction of nasal deformity in 29 patients. Intraoperative direct anthropometric measure ments of nostril height and nostril floor and comparison with the normal side were done. They have reported significant relapse of the nasal deformity during the 9-month follow-up and recommend primary overcorrection as a solution.