Primary Cleft Rhinoplasty: Long-Term Outcomes of a Single Technique Used for Over Two Decades
Matthew A. Wright, MD1, Karel-Bart Celie, MD2, Jeffrey A. Ascherman, MD1.
1Division of Plastic Surgery, Columbia University Irving Medical Center, New York, NY, USA, 2Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA.
Background: Primary cleft rhinoplasty has become widely accepted owing to evidence of improved outcomes and need for fewer revisions. Several techniques have been described, but few surgeons have reported long-term outcomes of repairs performed via a single method. The present study examines long-term outcomes of a single surgeonís experience over 24 years using the same primary cleft rhinoplasty technique. This method requires no additional incisions and, throughout the senior authorís long-term experience, has yielded excellent results. Methods: All patients undergoing primary cleft rhinoplasty by the senior author at the time of unilateral cleft lip repair from 1996 to 2018 were selected for retrospective review. Patients older than three years at the time of repair or lacking documented follow-up were excluded. The method utilized in all of these patients begins with the incisions of a rotation-advancement lip repair followed by undermining of the cleft-side lower lateral cartilage (LLC) from its abnormal skeletal base. The anterior, and majority of the posterior, surfaces of the LLC are then released from the surrounding nasal skin envelope. The cleft side LLC is subsequently repositioned and sutured in a more anatomical configuration. The entire rhinoplasty is completed through the cleft lip repair incisions, with no need for intranasal incisions. The primary outcome was need for secondary rhinoplasty. Results: Fifty-six patients met inclusion criteria. Twenty-three percent of patients presented with other congenital comorbidities, with the most common being cardiac defects. Fifty-seven percent of clefts were classified as complete, and the remainder were incomplete. Median follow-up time was 7.09 years (IQR: 1.38-12.34). There were no perioperative or postoperative nasal complications. No school-aged patients or their families requested or required additional nasal surgery prior to beginning school. Thirteen patients had follow-up beyond fifteen years of age, four of whom underwent definitive rhinoplasties as adolescents (7.1% of cohort; 30.8% of patients with follow-up beyond age fifteen). Of the remaining nine patients seen beyond age fifteen, none were seeking additional rhinoplasty at last follow-up. Conclusions: This series represents one of the longest-running published experiences of primary cleft rhinoplasty. Utilizing a technique which requires no nasal incisions, the senior author has had excellent long-term results, with no need for any elementary school age rhinoplasties and with the majority of patients with follow-up beyond age fifteen not requiring a rhinoplasty in adolescence.
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