Long-term effect of primary cleft rhinoplasty on secondary cleft rhinoplasty in patients with unilateral cleft lip-cleft palate

Haddock NT, McRae MH, Cutting CB.

What this paper says

In 116 adolescent cleft rhinoplasties, patients whose nose had been repaired at the time of infant lip repair by the same surgeon had more symmetric tip domes (p = 0.001) and needed the most complex revision technique less often (26% versus 60%).

Overview

A cleft lip distorts the nose, and surgeons disagree about whether to reshape the nose during the infant lip repair or wait. The senior author always does a primary nasal repair with the lip. This review examines whether that early repair changes what is needed at the definitive rhinoplasty in adolescence.

Sections of note

Retrospective chart review of all unilateral cleft secondary rhinoplasties by the senior author, 2001 to 2009: 116 patients.
Group A: 44 patients whose original lip repair, with primary rhinoplasty, was done by the senior author. The rest had lip repair elsewhere.
Group A: Dibbell rhinoplasty 26%, Potter rhinoplasty 5%, Tajima inverted-U incision 70%, alar base resection 53%.
Other patients: Dibbell 60%, Potter 0%, Tajima 76%, alar base resection 64%.
Group A had significantly greater dome symmetry between cleft and non-cleft sides (p = 0.001); nostril apex height was more symmetric but not significantly (p = 0.105).
Level of evidence: therapeutic, IV.

What it means for a patient

Correcting the nose at the time of a baby's lip repair appears to leave a more symmetric tip and a simpler operation in the teenage years.
The comparison group had lip repairs by different surgeons, so surgeon skill and technique differences, not only timing, may explain the gap.
Retrospective and single surgeon; patient-rated outcomes are not reported.

Why this paper matters

It supports primary cleft rhinoplasty, once avoided for fear of harming growth, with long-term data from a high-volume cleft center. A randomized comparison does not exist and is unlikely.

Terms

Unilateral cleft lip: a birth gap on one side of the upper lip, which pulls the nostril and tip out of shape.
Primary cleft rhinoplasty: reshaping the nose during the infant lip repair.
Secondary cleft rhinoplasty: the definitive nose operation done in adolescence.
Dome: the highest point of each tip cartilage.
Tajima inverted-U incision: an incision along the nostril rim used to lift and reposition the cleft-side tip cartilage.
Alar base resection: removing a wedge of tissue at the nostril base to narrow it.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“The senior author routinely performs primary nasal reconstruction with every cleft lip repair. This addresses the nasal tip asymmetry and simplifies the definitive secondary rhinoplasty in adolescence. Methods: A retrospective chart review was completed of all unilateral cleft secondary rhinoplasties performed by the…”

Excerpt; the full abstract is on PubMed.