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

Primary Cleft Rhinoplasty: A Systematic Review of Results, Growth Restriction, and Avoiding Secondary Rhinoplasty PEDIATRIC/CRANIOFACIAL

Ian Zelko, DO Eric Zielinski, MD Chiara N. Santiago, BA Lee W. T. Alkureishi, MBChB Chad A. Purnell, MD Chicago, IL

Background: Primary rhinoplasty during correction of unilateral cleft lip con tinues to be a topic of debate because of concerns that early nasal intervention may affect nasal and maxillary development over the long term. This study aims to determine the volume and quality of evidence for and against primary uni lateral cleft rhinoplasty. Methods: A systematic review was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were pulled from PubMed and EMBASE and screened by title and abstract. Studies with human participants undergoing rhinoplasty at the time of unilateral cleft lip repair and some evaluation of the nasal outcome were included. Studies with a large proportion of syndromic patients, case reports, editorials, letters, reviews, studies exclusive to bilateral clefts, and studies not available in English were excluded. Those that met criteria were then systematically reviewed. Results: Twenty-five articles were included. Ten articles that assessed the results of primary rhinoplasty subjectively all supported cleft lip repair with primary rhi noplasty. Sixteen articles assessed the results of primary rhinoplasty objectively, with 15 supporting primary rhinoplasty during cleft lip repair. Eight of nine studies that evaluated nasal growth and development over time found no restric tion in nasal development. Five studies with a follow-up period of at least 6 years found that the percentage of patients who avoided revision rhinoplasty ranged from 43% to 100%. There were significant risks of bias in the majority of studies. Conclusion: The majority of studies reviewed support that primary rhinoplasty during unilateral cleft lip repair results in good outcomes with limited or no effect on nasal growth. (Plast. Reconstr. Surg. 151: 452e, 2023.)

S ince the first reports of cleft lip repair, sur geons have continued to innovate to maxi mize functional and aesthetic results. During a large portion of this time, there was a fear that correcting the cleft nasal deformity would disturb nasal or maxillary development. In the 1950s, Gelbke 1 challenged this idea by performing a pri mary rhinoplasty during cleft repair. His invasive approach ultimately led to poor results, which propagated concerns about early nasal interven tions. Embryologic research by Latham 2 in 1970 led From the Division of Plastic and Reconstructive Surgery, University of Illinois College of Medicine at Chicago. Received for publication July 7, 2021; accepted March 11, 2022. Presented at the 78th Annual Meeting of the American Cleft Palate–Craniofacial Association, held virtually, April 29 through May 1, 2021. Copyright © 2022 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000009924

to further apprehension regarding primary rhino plasty through the “septal concept of facial growth.” His experiments demonstrated that the nasal sep tum, by means of the septopremaxillary ligament, transmits a force that induces growth of the maxilla. In the 1970s, physicians began to revisit pri mary rhinoplasty (PR) during cleft lip repair. McComb postulated that the procedure could

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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