Primary Cleft Rhinoplasty: A 22-year Retrospective Review of a Single Technique

Field: Medicine (Health Sciences)

PURPOSE: Repair of the cleft lip nasal deformity at the time of the initial cheiloplasty has become widely accepted owing to evidence of both improved outcomes and need for fewer revisions.1 Patients may require additional rhinoplasties before beginning school, if severe, and again in adolescence. Several primary rhinoplasty techniques exist, and few surgeons have long-term series of a single cleft rhinoplasty repair method. The senior author has over 20 years of experience performing the same primary cleft rhinoplasty repair based on a technique described by Salyer.2 The purpose of this study is to examine long-term outcomes of this technique. METHODS: An Institutional Review Board-approved, retrospective review was conducted on all patients who underwent a cleft rhinoplasty by the senior author at the time of their primary cleft lip repair between January 1996 and January 2018. Patients above 3 years old at the time of the repair were excluded. RESULTS: Of the 60 patients who met the inclusion criteria, cleft type was as follows: 22 UCL-L (36.7%), 10 UCL-R (16.7%), 12 UCL/P-R (20.0%), and 16 UCL/P-L (26.7). Thirty-seven (61.7%) were male, and 23 (38.3%) were female. Seventeen (28.3%) presented with other congenital comorbidities, most commonly cardiac. The median age at surgery was 3 months. Degree of lip clefting was noted for 57 patients, of which 31 (54.4%) were complete and 26 (45.6%) were incomplete. No patient had short-term complications related to their initial cleft lip and rhinoplasty repair, such as bleeding or airway compromise. Fifty-two (86.7%) patients had follow-up appointments in the medical record, with an average follow-up of 6.27 ± 5.56 years (0.01–19.3). Average age at last follow-up appointment was 6.60 ± 5.55 years (0.2–20.0). Thirty-three (63.5%) and 27 (51.9%) were above the ages of 3 and 5 years old, respectively, at last follow-up. None of the school-aged patients required additional surgical correction of the cleft nose deformity before beginning school. Eight (15.4%) patients had follow-up beyond 16 years, with ages ranging from 16 to 20. Two of these had definitive rhinoplasties as adolescents. Of the remaining 6 patients beyond 16 years old, none was seeking an additional rhinoplasty at last follow-up, and thus never required an additional nasal procedure beyond the rhinoplasty performed at the time of initial cleft lip repair. CONCLUSIONS: This is one of the longest-running, single-surgeon cleft rhinoplasty review series. Our patient demographics are consistent with the literature. The cleft rhinoplasty technique described by Salyer2 results in no additional incisions, is performed at the time of the initial cleft lip repair, and has yielded excellent long-term results in this series. The senior author has not needed to perform elementary school age rhinoplasties on any patients, and the majority of patients with follow-up beyond 16 years (6 of 8, or 75%) have also not required a rhinoplasty in adolescence. REFERENCES: 1. Henry C, Samson T, Mackay D. Evidence-based medicine: the cleft lip nasal deformity. Plast Reconstr Surg. 2014;133:1276–1288. 2. Salyer KE. Primary correction of the unilateral cleft lip nose: a 15-year experience. Plast Reconstr Surg. 1986;77:558–568.