Use of Routine Prospective Functional and Aesthetic Patient Satisfaction Measurements in Secondary Cleft Lip Rhinoplasty

van Zijl FVWJ, Versnel S, van der Poel EF, Baatenburg de Jong RJ, Datema FR.

PubMed 30326520 Publisher (DOI)Free full text (PMC)

What this paper says

Among 66 cleft lip rhinoplasty patients with sufficient follow-up, mean NOSE breathing scores improved from 30.8 to 19.2 and Utrecht Questionnaire scores from 13.1 to 7.1, both P below .001.

Overview

Cleft lip nose treatment is delivered in centralized centers where outcome reporting is increasingly expected. This pilot cohort study describes an automated system that collects patient-reported scores before and after surgery and feeds them into a live dashboard, and reports what it showed.

Sections of note

Prospective analytic cohort pilot of 123 consecutive patients referred for secondary cleft lip rhinoplasty from July 1, 2014, to March 31, 2018, at an academic teaching hospital.
123 patients: 68 male, 55 female, mean age 23 years, range 17 to 68.
103 patients were eligible for surgery: 57 male, 46 female, mean age 22 years, range 17 to 50.
Instruments: the NOSE scale and Utrecht Questionnaire, both 0 to 100 with lower better, plus visual analogue scales from 0, no obstruction, to 10, completely blocked.
Assessment points were preoperative and 3 and 12 months after surgery; data fed a customized web-based dashboard.
Among 66 patients with sufficient follow-up, mean NOSE sum score improved from 30.8 SD 27.6, a moderate problem, to 19.2 SD 22.2, a very mild problem, P below .001.
Mean Utrecht Questionnaire score fell from 13.1 SD 5.6 to 7.1 SD 3.3, P below .001. Level of evidence 4.

What it means for a patient

Breathing moved from a moderate problem to a very mild one on average after secondary cleft rhinoplasty.
Appearance scores also improved significantly on a separate validated instrument.
Only 66 of 123 referred patients had enough follow-up to contribute outcome data.
Limits: one center, no comparison group, level 4 evidence, and wide standard deviations indicating substantial variation between patients.

Why this paper matters

Secondary cleft rhinoplasty outcomes are rarely reported with validated instruments, and centralized cleft care makes comparison between centers plausible if measurement is standardized. This shows routine collection is feasible without disrupting practice. Comparison across surgeons still requires similar patient populations.

Terms

Secondary cleft lip rhinoplasty: Nose surgery after the original cleft lip repair, later in life.
NOSE scale: The Nasal Obstruction Symptom Evaluation, a validated blockage questionnaire.
Utrecht Questionnaire: A validated instrument scoring outcome in aesthetic rhinoplasty.
Prospective cohort: A group tracked forward in time as events occur.
Dashboard: A screen displaying live summarized data.

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

Abstract

Importance: Patients, governments, health care providers, and insurance companies show an increased interest in health outcomes, especially in centralized medical care, such as cleft lip nose treatment. Transparent outcome reporting requires a thorough methodological design, dedicated prospective data collection process, and, preferably, no interference with the efficacy of daily practice.

Objective: To describe the implementation of an automated and prospective secondary cleft lip rhinoplasty outcome routine.

Design, Setting, And Participants: A prospective analytic cohort pilot study was conducted among 123 consecutive patients referred for secondary cleft lip rhinoplasty from July 1, 2014, to March 31, 2018, at an academic teaching hospital.

Exposures: Secondary cleft lip rhinoplasty or revision.

Main Outcomes And Measures: Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (range 0-100, lower scores indicate better outcome), Utrecht Questionnaire (range 0-100, lower scores indicate better outcome), and visual analog scales (range 0-10: 0, no obstruction; 10, completely blocked nose) were obtained. Data were exported for automated statistical outcome analysis that was supported by graphic output on a customized web-based dashboard.

Results: Of the 123 patients (68 male and 55 female; mean age, 23 years [range, 17-68 years]) included in the outcome routine, 103 patients (57 male and 46 female; mean age, 22 years [range, 17-50 years]) were eligible for surgery. The web-based dashboard provided demographic characteristics, reasons that surgery was not performed or indicated, and real-time, short- and long-term change in functional and aesthetic outcome after secondary cleft lip rhinoplasty. Among 66 patients with sufficient follow-up, mean (SD) Nasal Obstruction Symptom Evaluation sum scores after rhinoplasty improved from 30.8 (27.6), which is comparable to a moderate problem, to 19.2 (22.2), which is comparable to a very mild problem (P < .001), and mean Utrecht Questionnaire sum scores decreased from 13.1 (5.6) to 7.1 (3.3) (P < .001).

Conclusions And Relevance: Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The web-based dashboard used during patient counseling, selection, and management of expectations has the potential to compare results of secondary cleft lip rhinoplasty between surgeons and institutions provided that the populations share similar characteristics. The administrative interference with a busy daily practice was limited.

Level Of Evidence: 4.

Abstract as indexed by PubMed; the article is open access (PubMed Central).