Clinical Practice Trends and Postoperative Outcomes in Primary Cleft Rhinoplasty

Abstract

Purpose Optimal correction of the cleft nasal deformity remains challenging. The purpose of this study was to examine the practice patterns and postoperative course of patients undergoing cleft lip repair with rhinoplasty compared to those who have primary lip repair without rhinoplasty. Methods and Materials A retrospective cohort study was conducted based on the Kids’ Inpatient Database. Data were collected from January 2000 to December 2011 and included infants aged 12 months and younger who underwent cleft lip repair. The predictor variable was the addition of rhinoplasty at primary cleft lip repair. Primary outcome variables included hospital setting, year, and admission cost, while secondary outcome variables included length of stay and postoperative complication rate. Independent t-tests and chi-squared tests were performed. Continuous variables were analyzed by multiple linear regression models. Results The study sample included 4559 infants with 1422 (31.2%) who underwent primary cleft rhinoplasty. Over time, there was a significant increase in the proportion of cleft lip repairs accompanied by a rhinoplasty ( p < .01). A greater proportion of patients with unilateral cleft lips received simultaneous rhinoplasty with their lip repairs (33.8 vs 26.0% , p < .01). This cohort had a significantly shorter length of stay (1.6 vs 2.8 days , p < .01) when compared to children that underwent cleft lip repair alone. Conclusions Performing primary cleft rhinoplasty is becoming more common among cleft surgeons. Considering comparable costs and complication rates, a rhinoplasty should be considered during the surgical treatment planning of patients with cleft nasal deformities.

“Septoplasty” Performed at Primary Cleft Rhinoplasty: A Systematic Review of Techniques and Call for Accurate Terminology

“…1,9,11,15 Large-scale database studies have reported 33% to 50% of patients receiving some form of rhinoplasty at primary cleft lip repair. 3,4 Of those patients reported to undergo septoplasty with cleft lip repair, 78% of repairs occur under the age of 5 years, with a peak age of under 1 year. 40 Despite increased performance of septoplasty during primary cleft lip repair, there is no study detailing the scope of this procedure.…”

“…However, the past decade has seen a shift toward the involvement of nasal reconstruction in primary repair, with over half of cleft surgeons performing some form of primary rhinoplasty in infancy. 2–4…”

“…However, the past decade has seen a shift toward the involvement of nasal reconstruction in primary repair, with over half of cleft surgeons performing some form of primary rhinoplasty in infancy. [2][3][4] Although the primary correction of the septum at primary cleft lip repair is typically referred to as a septoplasty, this procedure may differ from septoplasty in facially mature patients. The purpose of our study is to compare techniques used in septoplasty in primary cleft repair to techniques used in adult septoplasty as 1 NYU Langone Health, New York, NY, USA reported in the literature.…”