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Volume 151, Number 3 • Primary Cleft Rhinoplasty

Table 4. Nasal Growth and Development Evaluations

Follow Up, Years

Patients, n

Comparison Group

Article

Measurement of Growth

Results

Anderl et al. 21 (2008)

130 Surgical team assessment of the following: nasal shape, nasal

>14 Age-matched norms

No growth impairment, septal position maintained, bone growth documented under alar base

tip symmetry, shape and position of alar cartilages, nasal length, nostril shape, columellar symmetry, signs of nasal hypoplasia

91 Septal deviation measured by Z (columella–frenulum) angle, assessed by midface refer ence points 70 Photometric measurements of nostril height, nostril width,

10–14 Cleft repair without septoplasty

Septal deviation: study group: severe (2%), moderate (15%), straight (83%); controls: severe (48%), moder ate (38%), straight (14%)

Gawrych and Janiszewska Olszowska 22 (2011) Nunez-Vil laveiran et al. 19 (2020)

>3 Study group Decreased nostril width ratio T1 → T2, increased ¼ medial height ratio T1 → T3, increased inner nostril height:width ratio on noncleft side T1 → T3

¼ medial part of nostril height, nasal sill height, nostril area compared with noncleft side; compared at four time points: T1 (pre operatively), T2 (3 to 12 months postoperatively), T3 (1 to 3 years postoperatively), and T4 (>3 years) vertical points marked, ratios calculated, nasal length and columella height assessed; compared at age 5 and 10 years

14 Lateral cephalogram, five

10 Study group From 5 to 10 years: nasal height

Yoshimura et al. 24 (2015)

increased (increased BC:AE ratio); nasal tip grew downward (decreased CD:BC ratio); increased columellar angle

20 Anthropometric measurements by caliper–nostril thickness, diameter, minor diameter, columellar width, length, nasal width, tip projection, nasolabial angle

6.2 Farkas norms Cleft columella shorter than Farkas: 6.1 versus 8.1 mm, no other statistical dif ferences

Morselli et

al. 25 (2012)

1,200 Author assessment

9 Study group No disturbance in nasal growth; “good nasal symmetry and shape in the vast majority of our patients” 3 Study group 24.8% increase in nasal tip projec tion, 28.8% increase in columellar growth, 12.3% increase in nasal width;

Byrd and

Salomon 12 (2000)

30 2D photographs, anthropomet ric measurements; compared growth at 6 months to 3 years

Kim et al. 27 (2004)

rhinoplasty does not interfere with nasal growth, nasal tip projection, or columella growth No growth restriction; no significant differences observed for most mea surements; significant differences: cleft group had greater nasal protrusion, tip/midline deviation, nasal tip angle, nasal tip protrusion width index, and alar width:mouth width ratio; less nasal bridge length and nasal tip projection compared with controls

52 3D photographs, eight linear, four angular, five propor

19 Age-matched norms

Seo et al. 13 (2020)

tional, one surface area, and one volume measurement performed by two evaluators

2D, two-dimensional; 3D, three-dimensional.

The easiest evidence to evaluate is when PR recipients were compared with patients who only had a lip repair, leaving the nose untouc hed. 16,24,25,27,29 The aforementioned studies had fol low-up periods ranging from 5 to 10 years. Morselli et al. 25 showed a significantly improved nostril thickness and decrease in septal deviation in those undergoing primary repair. Pinto et al. 16 showed significantly less septal deviation in patients under going PR. Brusse et al. 29 showed that although PR

did not improve symmetry, it did improve nostril direction, and resulted in fewer revision proce dures in 9 years of follow-up. Despite variation in the included studies, PR appears to improve nasal appearance and septal deviation overall.

Nasal Growth Restriction The concern that PR may cause restriction of nasal development was a major driving force

459e

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