Secondary cleft rhinoplasty: impact on self-esteem and quality of life

Overview

Most rhinoplasty outcome papers report what surgeons see in photographs rather than what patients feel. This study asked whether patients born with a cleft lip judge their own result the same way surgeons do, and whether the operation changes distress about appearance and general quality of life. Thirty-three patients were assessed before surgery and again one year after secondary cleft rhinoplasty.

Sections of note

• Patients rated nasal shape and nasal function on a visual analogue scale and completed the Rhinoplasty Outcome Evaluation.
• Nasal and sinus symptoms were measured with the Sino-Nasal Outcome Test, distress about appearance with the Derriford Appearance Scale, and daily-life impairment with the Sheehan Disability Scale.
• Two independent surgeons scored before and after photographs.
• Shape scores improved (p less than 0.0001) and function scores improved (p = 0.005). Rhinoplasty Outcome Evaluation scores improved (p less than 0.0001).
• Sino-Nasal Outcome Test scores fell (p = 0.006), appearance distress fell (p less than 0.0001), and quality of life rose (p = 0.01).
• Patient ratings did not correlate with the surgeons' photographic scores.

What it means for a patient

• Cleft-related nose surgery improved both how patients felt about their nose and how well they breathed at one year.
• Benefit extended past the nose itself into everyday confidence and functioning.
• Surgeon photograph scores did not track patient opinion, so a result graded well by a professional may not be the result the patient values.
• Follow-up stopped at 12 months and there was no comparison group, so longer-term durability is unknown.

Why this paper matters

Cleft rhinoplasty is a staged, technically difficult reconstruction, and this study measures it by the standard that matters to the person having it. The gap between patient and surgeon scoring supports using patient-reported questionnaires in routine practice. Durability beyond one year remains unanswered.

Terms

• Secondary cleft rhinoplasty: surgery to reshape the nose after an earlier cleft lip repair.
• Visual analogue scale: a sliding 0 to 100 rating a patient marks themselves.
• Rhinoplasty Outcome Evaluation: a short questionnaire scoring satisfaction with nasal appearance and breathing.
• Sino-Nasal Outcome Test: a questionnaire measuring nose and sinus symptoms.
• Correlation: a statistical measure of whether two sets of scores move together.