Rhinoplasty in Clefts: An 18-Year Retrospective Review

Farouk A.

What this paper says

Over 18 years one surgeon treated 800 patients of varying ages and cleft types, concluding that a perfectly normal nose is unusual but a reasonably good result is attainable.

Overview

Cleft rhinoplasty aims to restore normal nasal form, function and growth in patients born with a cleft, and no single protocol has proved satisfactory. Timing, choice of approach, non-surgical adjuncts and how outcomes should be assessed all remain contested. This review reports one surgeon's series across 18 years using a range of procedures.

Sections of note

800 patients of different ages and cleft types, all managed by a single surgeon over 18 years.
Procedures used included preoperative naso-alveolar molding and gingivoperiosteoplasty.
Primary rhinoplasty was performed by either closed or open approach.
Postoperative nasal stents and nasal molding were used.
Secondary open septorhinoplasty was performed where needed.
Outcomes were judged by panel assessment and by computer-assisted anthropometry, which the author found helpful. Results were described as satisfactory for most patients, parents and the surgeon panel.

What it means for a patient

Cleft nasal correction is presented as part of cleft lip repair rather than an optional extra done later.
Treatment spans years and stages, from shaping in infancy through to definitive surgery in adolescence or adulthood.
The author states plainly that a nose with no residual deformity is unusual, which is a realistic expectation to carry into the process.
Single surgeon, retrospective, no comparison group, no complication rates and no numeric outcome data in the abstract, so the series describes practice rather than measuring which protocol works best.

Why this paper matters

Cleft care is delivered over a whole childhood, so long-run single-team series are among the few sources able to describe what a full protocol produces. Eighteen years and 800 patients is unusual scale. The controversies named at the outset, particularly the timing of surgery, are not resolved by the paper.

Terms

Cleft: a gap in the lip or palate present at birth, which also distorts the nose.
Naso-alveolar molding: shaping the nose and gum with a removable appliance in infancy before surgery.
Gingivoperiosteoplasty: surgical repair of the gum and its lining to bridge a cleft in the bone.
Nasal stent: a device worn inside the nostril after surgery to hold its shape.
Septorhinoplasty: rhinoplasty combined with straightening of the nasal partition.
Anthropometry: standardised measurement of body dimensions, here of the nose.

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

From the abstract

“Cleft rhinoplasty has spurred much interest in literature because of the difficult task in obtaining a normal nasal form, function, and development. The pursuit of perfection has resulted in myriad techniques, modifications, and innovations to optimize results, but no one protocol or algorithm was proved to be…”

Excerpt; the full abstract is on PubMed.