Northeastern Society of Plastic Surgeons

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Primary Rhinoplasty for Unilateral Cleft Lip: A Long-Term Cohort Assessment of Aesthetic and Anthropometric Outcomes
Jinggang Ng*, Manisha Banala, Jonathan Sussman, Benjamin Massenburg, Dominic Romeo, Meagan Wu, Oksana A. Jackson, David Low, Jesse A. Taylor, Jordan W. Swanson
Children's Hospital of Philadelphia, Philadelphia, PA

Background

The decision to undertake rhinoplasty maneuvers during cleft lip repair remains controversial. Little data compares long-term outcomes with and without primary rhinoplasty (PR). This study compared nasolabial outcomes in cohorts with unilateral cleft lip treated with and without PR using standardized aesthetic and anthropometric assessments.

Methods

A retrospective review was conducted of children who underwent unilateral cleft lip repair. Anthropometric analyses were performed on standardized photographs taken 5 years postoperatively. Photographic aesthetic assessment was performed by laypersons using Americleft nasolabial appearance reference scales and pairwise comparisons.

Results

Among 208 patients, 155 (74.5%) and 53 (25.5%) underwent lip repair with and without PR at 4.5±1.1 months. History of PR (β=0.345, p=.037) and a lower cleft lip severity index (β=-0.341, p<.001) predicted superior pairwise rank at 4.9±1.9 years of age. PR predicted decreased columellar deviation angle (CDA) (β=-2.375, p=.019) and improved nostril symmetry (β=0.111, p=.038). Increased columellar-labial angle (CLA) (r=0.27, p=.002), improved nostril symmetry (r=-0.23, p=.01), and decreased CDA (r=- 0.45, p<.001) correlated with superior ratings. Patients with fewer than 20 days of postoperative nasal stenting had inferior lateral ratings (2.4±0.6 versus 2.1±0.5, p=.005). Those who underwent surgery younger than 5.3 months had inferior nasal projection (Goode's ratio 0.56±0.09 versus 0.62±0.08, p=.006).

Conclusions

PR for unilateral cleft lip offers superior aesthetic results in early childhood by layperson and anthropometric assessments. Specific improved characteristics from PR—CDA and nostril symmetry—most greatly influence layperson perception of nasal appearance. Older age at surgery predicted increased nasal projection, while prolonged nasal stenting predicted superior profile appearance.


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