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Primary Cleft Rhinoplasty: A Systematic Review of Results, Growth Restriction, and Avoiding Secondary Rhinoplasty
Ian Zelko1, Eric Zielinski1, Chiara N Santiago1
1From the Division of Plastic and Reconstructive Surgery, University of Illinois College of Medicine at Chicago.
Insights
Primary rhinoplasty during cleft lip repair shows good outcomes and minimal impact on nasal growth. This systematic review found evidence supporting early nasal intervention in unilateral cleft lip cases.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Debate exists regarding primary rhinoplasty in unilateral cleft lip repair due to concerns about long-term nasal and maxillary development.
- This study systematically reviews evidence for and against primary unilateral cleft rhinoplasty.
Approach:
- Systematic review of PubMed and EMBASE databases.
- Included studies focused on human participants undergoing primary rhinoplasty during unilateral cleft lip repair.
- Excluded syndromic patients, case reports, reviews, and bilateral cleft studies.
Key Points:
- 25 articles were reviewed, with most supporting primary rhinoplasty.
- Objective assessments showed 15 of 16 studies favored primary rhinoplasty.
- 89% of studies evaluating nasal growth found no restriction; 5 studies with ≥6-year follow-up showed 43-100% avoided revision rhinoplasty.
- Majority of studies had significant risks of bias.
Conclusions:
- The majority of evidence supports primary rhinoplasty during unilateral cleft lip repair.
- Primary rhinoplasty yields good outcomes with limited impact on nasal growth.
Background:
Primary rhinoplasty during correction of unilateral cleft lip continues to be a topic of debate because of concerns that early nasal intervention may affect nasal and maxillary development over the long term. This study aims to determine the volume and quality of evidence for and against primary unilateral cleft rhinoplasty.
Methods:
A systematic review was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were pulled from PubMed and EMBASE and screened by title and abstract. Studies with human participants undergoing rhinoplasty at the time of unilateral cleft lip repair and some evaluation of the nasal outcome were included. Studies with a large proportion of syndromic patients, case reports, editorials, letters, reviews, studies exclusive to bilateral clefts, and studies not available in English were excluded. Those that met criteria were then systematically reviewed.
Results:
Twenty-five articles were included. Ten articles that assessed the results of primary rhinoplasty subjectively all supported cleft lip repair with primary rhinoplasty. Sixteen articles assessed the results of primary rhinoplasty objectively, with 15 supporting primary rhinoplasty during cleft lip repair. Eight of nine studies that evaluated nasal growth and development over time found no restriction in nasal development. Five studies with a follow-up period of at least 6 years found that the percentage of patients who avoided revision rhinoplasty ranged from 43% to 100%. There were significant risks of bias in the majority of studies.
Conclusion:
The majority of studies reviewed support that primary rhinoplasty during unilateral cleft lip repair results in good outcomes with limited or no effect on nasal growth.
