Secondary Cleft Rhinoplasty: What, When, And How Often Is It Being Done?
Nikhil D. Shah, BS1, Narainsai K. Reddy, BA2, Joshua Weissman, BAA1, Jenna Stoehr, BA1, Sarah Applebaum, MD1, Arun K. Gosain, MD, FACS1.
1Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA, 2Texas A&M Health Science Center College of Medicine, Engineering Medicine (EnMed), Houston, TX, USA.
PURPOSE: To identify national practice patterns for secondary cleft rhinoplasty and to include preferred age of operation and variation in surgical technique relative to patient age.
METHODS: Program coordinators of all 193 cleft teams certified by the American Cleft Palate-Craniofacial Association (ACPA) were requested to forward a survey to their team cleft surgeons.
RESULTS: Fifty-five surgeons completed the survey, representing forty (21%) of ACPA-approved cleft teams. The average age that surgeons first consider intermediate cleft rhinoplasty is 5.83 +/- 2.66 years, and that for definitive (final) cleft rhinoplasty is 15.86 +/- 1.73 years. Resolving airway obstruction was the reason most cited for performing septoplasty. Significantly more surgeons consider performing a septoplasty during definitive rhinoplasty than during intermediate rhinoplasty (Table 1). However, the indication for septoplasty in the two procedures does not differ. Intermediate cleft rhinoplasty was more often done through a closed approach, whereas definitive cleft rhinoplasty was more often done through an open approach. Autologous septal cartilage was the most common source for tip augmentation, columellar support, and dorsal support. Cadaveric cartilage, when used, was more often utilized in intermediate cleft rhinoplasty.
CONCLUSION: Timing for secondary cleft rhinoplasty and differences in technique relative to patient age have not previously been evaluated. The present study highlights the need for improved data collection to establish best practice for timing, technique, and outcomes of secondary cleft rhinoplasty.
| Item | Intermediate Cleft Rhinoplasty | Definitive Cleft Rhinoplasty | p-value |
| Percentage of cases where septoplasty is considered (Mean) | 30% | 70% | <0.001* |
| Indication for septoplasty | 0.757 | ||
| Nasal Airway Obstruction | 58% | 66% | |
| Average frequency of surgical approach utilized | <0.001* | ||
| Open or external | 39% | 61% | |
| Closed | 95% | 5% | |
| Source for Tip Augmentation | |||
| Autologous Septum | 35% | 58% | 0.003* |
| Cadaveric Cartilage | 22% | 5% | 0.046* |
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