Cleft Rhinoplasty Operative Trends From 959 Cases In A Single Institution
Liana Cheung, MBBS, Jinggang Ng, BA, MA, Dillan F. Villavisanis, BA, Jessica D. Blum, BA, MSc, Daniel Y. Cho, MD PhD, Oksana Jackson, MD, David W. Low, MD, Jordan W. Swanson, MD MSc, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE:
This study evaluated operative trends and photomorphometric outcomes of 959 cases over 15 years in a single institution.
METHODS:
All cleft rhinoplasty procedures from January 2006 to December 2020 were retrospectively reviewed. Cohort and subgroup statistical analyses assessed dataset trends. Photomorphometric analyses on basal, frontal and lateral views were conducted on subgroups comparing postoperative outcomes, age of repair, cleft laterality and cartilage grafts used. Symmetry (absolute nasal width ratio, bilateral nostril height-to-width ratio), nasal projection (pronasale height to alar width ratio, Goode's ratio) and nasolabial angles were compared.
RESULTS:
Overall trends demonstrated a distinct trimodal distribution over three age cohorts (0-3.9; 4-12.9; 13-25 years).
Institutionally, the rate of primary cleft rhinoplasties (PCR) increased over time (p=0.015). In the intermediate mixed-dentition cohort (IMD), cleft rhinoplasties were performed concurrently with alveolar cleft repair and iliac cap cartilage was the increasingly preferred graft donor source over time (p=0.0038). Rib grafts were used in a minority (10.9%) of the definitive rhinoplasty cohort.
Photomorphometric analyses demonstrated quantifiable improvement post-operatively across all cohorts, including improvement in nostril symmetry (all p<0.001) and tip projection (pronasale height to alar width ratio all p<0.001). Unilateral clefts had significantly improved post-operative nasolabial angle than bilateral clefts (PCR and IMD p<0.001).
CONCLUSION: Our institutional trends demonstrated a trimodal age distribution, with cartilage grafts from distant sites utilized selectively according to patient age and concurrent procedures. Photomorphometric assessment revealed improvements in nostril symmetry, nasal tip projection, and nasolabial angle in all cohorts.
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