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

Volume 151, Number 3 • Primary Cleft Rhinoplasty

be done without disrupting nasal growth. This was the beginning of a major paradigm shift in cleft care that continues to evolve. Since that time, PR has become a much more accepted part of cleft repair, potentially even the standard of care, thanks to successful reports from McComb, Mulliken, Millard, and Salyer, among others. 3–7 However, debate continues regarding whether PR should be performed and how much should be done at the time of rhinoplasty. We designed this study to collect, organize, and interpret the avail able data in the literature regarding this topic. The principal goal of this study was to deter mine the volume and quality of evidence for and against primary unilateral cleft rhinoplasty. Secondary goals were to assess how PR affects nasal growth and in what proportion of patients this eliminates the need for subsequent rhino plasty. In this systematic review, we also describe the different surgical approaches in the literature. METHODS This systematic review followed the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. 8 Searches were performed in PubMed in January of 2020. A later search of EMBASE was performed of all articles available at the time of the primary PubMed search. The following search terms were used: (cleft rhinoplasty) and (primary cleft lip nose repair), including MeSH

terms when applicable. No restrictions were held against the study setting, surgical approach, eval uation of outcomes, or date published. Criteria for inclusion were (1) human patients undergoing rhinoplasty at the time of unilateral cleft lip repair and (2) some evaluation of the nasal outcome. Exclusion criteria were (1) studies with a large proportion of syndromic patients, (2) case reports, (3) editorials, (4) letters, (5) reviews, (6) studies exclusive to bilateral clefts, and (7) studies not available in English. Studies were first screened by title and abstract. If the study met cri teria after this, the entire article was then reviewed. Two reviewers performed screening and evalua tion. Articles were reviewed for risk of bias using the Cochrane Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. 9 RESULTS The PubMed searches produced 1237 results. The EMBASE search produced 1121 articles. A total of 163 articles were selected for abstract review after duplicates were removed. After abstract screening, 37 publications were chosen for detailed full-article review. Of these, a total of 25 publications are included in this system atic review. One study included four syndromic patients in the study population, but because this was a small minority of the patients in these studies, we did not exclude this report from our review 10 (flow diagram, Fig. 1).

Fig. 1. Flow diagram showing number of articles included at each step of the systematic review.

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