[Functional and aesthetic outcome after surgery on cleft lip nasal deformities]

Patients with cleft lip nasal deformities suffer not only from aesthetic stigmatization but also from functional problems. Many different techniques to operate on this deformity have been described.

24 patients (16 male and 8 female, aged 20-56 years) have been enrolled in this study. A subjective value of the postoperative result of aesthetics and function was measured by a visual analogue scale ranging from - 5 (significant aggravation) to +5 (significant improvement) including 0 (no change). Additionally the primary nasal symptoms (PNS) of the SNOT-20 GAV were collected.

10 primary surgeries and 14 revisions were performed with 20 open and 4 endonasal approaches. In 11 cases a composite graft from the concha was used. 75% of the patients looked up to both features aesthetic and function favorably. The mean evaluation was +3.4 for aesthetics and +2.6 for function. 91% of the patients who received a composite graft looked up to the result favorably. The mean PNS were 14.

Altogether good results especially concerning the subjective aesthetics can be achieved by precise preoperative evaluation and the described operative algorithm. In our sample of patients better results could be accomplished by using composite grafts. Nevertheless it seems to be more difficult to improve the function of cleft lip nasal deformities than the aesthetics. More innovations and objective measurements are needed to come up to the still unsolved problems of the challenging surgery of cleft lip nasal deformities.