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

Volume 151, Number 3 • Primary Cleft Rhinoplasty

Further granularity between techniques is beyond the power of the current literature, as there is too much heterogeneity between study techniques. Several authors did perform comparative tech nique studies in PR. However, all of these studies have concerns for confounding, as different inter ventions occurred during different time intervals. Three articles found improved aesthetic or func tional results when implementing septoplasty with rhinoplasty. 16,22,23 There were two studies compar ing more aggressive cleft side alar interventions with more conservative approaches. Patients whose nasal deformity was overcorrected experienced a significantly increased alar and nostril height ratio compared with those who underwent cleft repair with PR and no overcorrection. 26 This is corrobo rated by Tang et al., 33 who showed that relapse occurred after a nonovercorrected nasal correc tion. James et al. 28 compared two techniques from two centers (Pigott’s and McComb’s) with age matched normal controls. The McComb technique resulted in improved symmetry on worm’s-eye view compared with the Pigott technique; however, both groups had significant asymmetry on worm’s eye compared with age-matched controls. More work is needed to help identify a range of primary rhinoplasty techniques that produce ideal results and comparative data from multiple centers will be required. The limitations of the existing literature do not provide a clear picture. CONCLUSIONS The large majority of subjective and objective outcomes studies support that primary cleft rhi noplasty results in better outcomes than no rhi noplasty and that nasal growth is not inhibited by the technique. There are significant weaknesses in the available literature common to many stud ies in craniofacial surgery. Chad A. Purnell, MD The Craniofacial Center University of Illinois–Chicago 811 South Paulina Street

3. Mulliken JB. Correction of the bilateral cleft lip nasal defor mity: evolution of a surgical concept. Cleft Palate Craniofac J . 1992;29:540–545. 4. McComb H. Primary correction of unilateral cleft lip nasal deformity: a 10-year review. Plast Reconstr Surg . 1985;75:791–799. 5. McComb H. Treatment of the unilateral cleft lip nose. Plast Reconstr Surg . 1975;55:596–601. 6. Millard DR Jr. The unilateral cleft lip nose. Plast Reconstr Surg . 1964;34:169–175. 7. Salyer KE. Primary correction of the unilateral cleft lip nose: a 15-year experience. Plast Reconstr Surg . 1986;77:558–568. 8. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Reprint: Preferred reporting items for systematic reviews and meta analyses: the PRISMA statement. Phys Ther . 2009;89:873–880. 9. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interven tions. BMJ . 2016;355:i4919. 10. Tse RW, Knight R, Oestreich M, Rosser M, Mercan E. Unilateral cleft lip nasal deformity: three-dimensional analy sis of the primary deformity and longitudinal changes fol lowing primary correction of the nasal foundation. Plast Reconstr Surg . 2020;145:185–199. 11. McComb HK, Coghlan BA. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac J . 1996;33:23–30; discussion 30. 12. Byrd HS, Salomon J. Primary correction of the unilateral cleft nasal deformity. Plast Reconstr Surg . 2000;106:1276–1286. 13. Seo HJ, Denadai R, Pai BC, Lo LJ. Digital occlusion setup is quantitatively comparable with the conventional dental model approach: characteristics and guidelines for orthog nathic surgery in patients with unilateral cleft lip and palate. Ann Plast Surg . 2020;85:171–179. 14. Ahuja RB. Primary rhinoplasty in unilateral cleft patients: the “limited open” approach and other technical consider ations. Cleft Palate Craniofac J . 2006;43:492–498. 15. Cussons PD, Murison MS, Fernandez AE, Pigott RW. A panel based assessment of early versus no nasal correction of the cleft lip nose. Br J Plast Surg . 1993;46:7–12. 16. Pinto V, Piccin O, Burgio L, Summo V, Antoniazzi E, Morselli PG. Effect of early correction of nasal septal defor mity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency. Int J Pediatr Otorhinolaryngol . 2018;108:190–195. 17. Lu TC, Lam WL, Chang CS, Kuo-Ting Chen P. Primary cor rection of nasal deformity in unilateral incomplete cleft lip: a comparative study between three techniques. J Plast Reconstr Aesthet Surg . 2012;65:456–463. 18. Lu TC, Yao CF, Lin S, Chang CS, Chen PK. Primary sep tal cartilage graft for the unilateral cleft rhinoplasty. Plast Reconstr Surg . 2017;139:1177–1186. 19. Nunez-Villaveiran T, Fahradyan V, McNinch NL, Valentine A, Larson H, Murthy AS. Photogrammetric outcomes of pri mary nasal correction in unilateral cleft lip patients: early childhood results from a single surgeon’s experience. Ann Plast Surg . 2020;84:53–61. 20. Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair: a 33-year experience. J Craniofac Surg . 2003;14:549–558. 21. Anderl H, Hussl H, Ninkovic M. Primary simultaneous lip and nose repair in the unilateral cleft lip and palate. Plast Reconstr Surg . 2008;121:959–970. 22. Gawrych E, Janiszewska-Olszowska J. Primary correction of nasal septal deformity in unilateral clefts during lip repair: a long-term study. Cleft Palate Craniofac J . 2011;48:293–300.

Chicago , IL 60612 cpurnell@uic.edu Instagram: @Craniofacial_Surgeon Twitter: @ChadPurnellMD

REFERENCES 1. Gelbke H. The nostril problem in unilateral harelips and its surgical management. Plast Reconstr Surg (1946) 1956;18:65–75. 2. Latham RA. Maxillary development and growth: the septo premaxillary ligament. J Anat . 1970;107:471–478.

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