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

Volume 151, Number 3 • Primary Cleft Rhinoplasty

Table 2. Subjective Outcome Assessment Measures

Patients, n

Follow-Up, Years

Article

Subjective Measures

Comparison Group

Anderl et al. 31 (2008)

130 Surgical team assessment of the following: nasal shape, nasal tip symmetry, shape and position of alar cartilages, nasal

>14 Noncleft side and age-matched norms

length, nostril shape, columellar symmetry, signs of nasal hypoplasia

750 Author assessment

Up to 33 NA

Salyer et al. 20 (2003)

70 Five-point VAS score, assessed by two plastic surgeons, one NP, one PA

2.4 NA

Nunez-Villaveiran et al. 19 (2020) Salyer 7 (1986)

400 Author assessment 1200 Author assessment

Up to 15 NA

9

NA

Byrd and

Salomon 12 (2000)

Lu et al. 18 (2017)

97 Five-point VAS score, assessed by two plastic surgeons and three laypersons, blinded 66 Five-point VAS score, assessed by one plastic surgeon and nine laypersons 20 NOSE scores: 0 (no concern) to 100 (severe concern) 35 Author’s colleague’s assessment 25 Three juniors of the plastic surgery team ranked outcomes (upper nasal perimeter

4.9 Cleft repair and rhinoplasty with graft ( n = 38) versus cleft repair and rhinoplasty without graft ( n = 59) 5 to 6 Closed rhinoplasty ( n = 21) versus bilateral rim incision ( n = 25)

Lu et al. 17 (2012)

versus Tajima incision cleft side and rim incision noncleft side ( n = 20)

5

Unilateral cleft repair without rhinoseptoplasty

Pinto et al. 16 (2018) Ahuja 14 (2006) Cussons et al. 15 (1993)

5 to 6 months

NA

10 Healthy children or patients with unilateral cleft repair without rhinoplasty

symmetry, nostril outline symmetry, overall aesthetics) from best to worst

NA, not applicable; NOSE, Nasal Obstructive Symptom Evaluation; NP, nurse practitioner; PA, physician’s assistant; VAS, visual analogue scale.

indirect anthropometric measurements, 11,19,24,27 3D indirect anthropometric measurements, 13 and direct anthropometric measurements. 25 Eight of the nine included studies (89%) found no restriction in nasal development. One article presented evidence for growth restriction, which was found in the nasal height:dorsum ratio and columellar angle. 24 Avoidance of Secondary Rhinoplasty Five studies calculated the percentage of patients in whom secondary rhinoplasty was not performed. 7,11,13,21,29 Only studies with a follow-up period of at least 6 years were included. The follow-up period ranged from 9 years 29 to 18 years. 11 The percentage of those who avoided revision rhinoplasty ranged from 43% 13 to 100%. 11,29 Complete results are presented in Table 5. DISCUSSION In this review, we sought to determine the amount and quality of evidence for primary cleft rhinoplasty, and secondarily, determine evidence for nasal growth restriction or avoidance of sec ondary rhinoplasty with PR. Despite the long history of concerns over performing PR, the over arching consensus in literature shows evidence in

support of the procedure. In this study, 21 of 22 studies supported performing PR. However, sim ply stating that the large majority of studies sup port PR is an oversimplification of the challenges of evaluating the existing literature. Nasal Anthropometrics To help minimize confounding and bias, it is simpler to look most closely at studies that measured objective outcomes, as these would be the most repeatable. Although 15 of 16 of these studies found favorable results, there is a wide range of follow-up time among articles. It is eas ily understandable that PR produces improved nasal symmetry early, but how long does this last? Tang et al.’s data suggest that even at 9 months, some relapse has occurred, but the amount is difficult to quantify given the type of measures used. 33 Three included articles 23,26,32 had follow-up periods ranging from 1 to 2 years, which is likely too short a follow-up to be clinically meaningful. However, multiple articles evaluated their patients more than 10 years later 11,13,22,24,28 and all showed improved results from PR, with the notable excep tion of Yoshimura et al. 24 These studies provide stronger evidence that PR does result in a lasting improvement in nasal shape. Another consideration is the measurement methodology used. With an array of different

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