Bilateral Cleft Lip Repair With and Without Primary Rhinoplasty: Comparing Two-Year Aesthetic and Anthropometric...

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Bilateral cleft lip repair presents complex aesthetic challenges.
• Optimizing nasal symmetry and appearance is a key goal in surgical management.
• Concurrent primary rhinoplasty (PR) versus non-primary rhinoplasty (NPR) approaches are debated for aesthetic outcomes.

Purpose of the Study:

• To compare aesthetic outcomes between PR and NPR in patients with bilateral cleft lip.
• To evaluate the influence of presurgical nasoalveolar molding (NAM) and cleft severity on aesthetic results.
• To identify key factors influencing layperson and anthropometric assessments of nasal appearance.

Main Methods:

• Retrospective review of 75 children undergoing bilateral cleft lip repair.
• Comparison of aesthetic outcomes using layperson surveys and anthropometric analysis.
• Assessment of presurgical nasoalveolar molding (NAM), nasal stenting, and cleft severity (Bilateral Cleft Lip Severity Index - BCLSI).

Main Results:

• Lower BCLSI scores correlated with superior aesthetic ratings.
• NAM failure leading to lip adhesion significantly impacted aesthetic outcomes negatively (p < .001).
• Overall, PR did not outperform NPR, but PR in the BCLSI3 group showed higher layperson scores (p = .036).
• PR with nasal stenting ≥21 days improved Goode's ratio (p < .001).

Conclusions:

• Presurgical nasoalveolar molding (NAM) significantly influences oronasal outcomes.
• Preoperative cleft severity is a crucial factor in guiding personalized surgical strategies.
• While PR may benefit specific subgroups (BCLSI3), overall aesthetic superiority over NPR was not demonstrated.