Primary Rhinoplasty Does Not Interfere with Nasal Growth: A Long-Term Three-Dimensional Morphometric Outcome Study in Patients with Unilateral Cleft

Overview

The main objection to operating on the cleft nose in infancy is that it might restrict nasal growth. This study measured patients who had that surgery between 1995 and 2002 and have now reached skeletal maturity, comparing them against matched people without a cleft.

Sections of note

• Three-dimensional nasal morphometric measurements, linear, angular, proportional, surface area and volume, from 52 consecutive patients, mean age 19 years SD 1.
• All had undergone primary rhinoplasty using the Noordhoff approach between 1995 and 2002 and reached skeletal maturity.
• 52 normal subjects matched for age, sex and ethnicity served as controls.
• No significant differences, all p above 0.05, for nasal height, alar width, dorsum angle, columellar angle, columellar-labial angle, tip to height ratio, nasal index, alar width to intercanthal distance ratio, nasal surface area, and nasal volume.
• The cleft group had significantly lower nasal bridge length and tip projection, p below 0.05.
• The cleft group had greater nasal protrusion, tip and midline deviation, nasal tip angle, tip protrusion width index, and alar width to mouth ratio.
• The authors state further imaging studies are needed to assess development of other nasal structures. Level of evidence IV.

What it means for a patient

• Operating on the cleft nose in infancy did not restrict overall nasal growth measured at around age 19.
• The differences that remain, a shorter bridge and less tip projection, reflect the underlying cleft rather than growth restriction.
• Residual deviation of the tip and midline persisted into adulthood.
• Limits: not randomized, single surgeon and technique, surface measurements only, and no comparison against cleft patients who did not have primary rhinoplasty.

Why this paper matters

The growth objection has kept some centers from operating on the cleft nose in infancy, and this provides measurements at skeletal maturity. Comparison against normal controls rather than untreated cleft patients is the design limitation. Internal structures were not imaged, which the authors flag as unfinished.

Terms

• Primary rhinoplasty: Nasal reshaping done at the same time as the first cleft lip repair in infancy.
• Skeletal maturity: The point at which bone growth is complete.
• Morphometric measurement: Measurement of shape and size.
• Nasal index: The ratio of nasal width to nasal height.
• Intercanthal distance: The distance between the inner corners of the eyes.