Operative Trends and Outcomes in Cleft Rhinoplasty: A Review of 875 Cases in a Single Institution
Liana Cheung1, Jesse A. Taylor1
1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
Background: The purpose of this study was to evaluate operative trends among 875 cases over 13 years in a single institution, and to compare nasal shape outcome measures based on age of repair and cleft laterality.
Methods: Cleft Rhinoplasty procedures from mid-2007 to 2020 were retrospectively reviewed. Appropriate statistical analyses were conducted to assess trends in the dataset. Photomorphometric analyses on basal, frontal and lateral views were conducted on four groups for comparison: bilateral and unilateral cleft patients with cleft rhinoplasty procedures during infancy concurrent with cleft lip repair (Age 0-3.9 years) and intermediate mixed dentition age (4-12.9 years). Patients who underwent cleft rhinoplasty between the ages of 4 to 12.9 years had pre-operative and post-operative photomorphometric analyses completed for comparison. Nasal ratios (nasal length to tip projection ratio, nasal width symmetry, nasal tip protrusion–to–alar base width ratio, nasal dome-to-columellar height ratio, nostril height-to-width ratio for nostril symmetry) and nasolabial angles were compared.
Results: Trends Age at time of cleft rhinoplasty was trimodal, with definitive age peaks in infancy (0-3.9 years), intermediate mixed dentition (4-12.9) and definitive rhinoplasty age (13-25). Notably, cleft rhinoplasty procedures were timed to coincide with cleft procedures including primary or revision cleft lip repair and alveolar bone graft repair. Laterality of cleft did not affect the incidence of concurrent tip rhinoplasties in primary cleft lip repairs (p=0.3235), but age at operation of concurrent rhinoplasty among bilateral cleft lip patients was older than unilateral cleft lip patients (p< 0.0001). Among intermediate mixed dentition age, cleft laterality also affected use of cartilage graft with bilateral clefts requiring more ear cartilage grafts (p=<0.0001) and unilateral cleft rhinoplasties requiring more nasal cartilage grafts (p=0.0056). Additionally, more iliac grafts were performed, particularly within the intermediate mixed dentition age (p=0.003758), but this increase was not significant within the proportion of cleft rhinoplasties completed in this age group (p=0.2687). Photomorphometric analysis For the 0-3.9-year cohort, primary cleft lip with concurrent rhinoplasty precluded pre-op metrics for comparison. The 4-12.9-year cohorts demonstrated post-operative improvement in nasal shape metrics across all ratios as seen in the diagram. Discussion The distinct trimodal age distribution within our single institution allowed us to further delineate the differences in cleft laterality and operative trends at different stages of patient cleft care. Photomorphometric analysis demonstrates quantifiable improvement in rhinoplasties for both bilateral and unilateral cleft patients.
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