Secondary Cleft Rhinoplasty: A National Survey of Surgical Practice by Accredited Cleft Palate Teams

Shah ND, Reddy NK, Weissman JP, Stoehr JR, Applebaum SA, Gosain AK.

PubMed 36381488 Publisher (DOI)Free full text (PMC)

What this paper says

Surveying 59 surgeons from 40 accredited US cleft teams, 88.1 percent perform intermediate cleft rhinoplasty, first considered at a mean age of 5.83 years, with definitive surgery considered at 15.86 years.

Overview

Patients with a cleft lip often have a primary rhinoplasty at the time of lip repair, and further correction is often needed later for both appearance and function. The study set out to establish current US practice patterns for that secondary surgery, surveying team surgeons affiliated with cleft care teams approved by the American Cleft Palate Craniofacial Association.

Sections of note

Survey of accredited cleft team surgeons; 40 teams responded, a 20.7 percent response rate, with 59 surgeons completing it.
Intermediate cleft rhinoplasty is performed by 88.1 percent of respondents.
Among those, the mean age first considered was 5.83 plus or minus 2.66 years.
The mean age for considering definitive surgery was 15.86 plus or minus 1.73 years.
In both one sided and two sided clefts, a closed approach was more common for intermediate surgery and an open approach for definitive surgery, P less than 0.001.
Use of the patient's own grafts was more common in definitive surgery, P less than 0.001.
Sixty five percent of respondents used the patient's own grafts in more than three quarters of their definitive procedures.
The authors state the considerable variability highlights a lack of consensus on this surgery.

What it means for a patient

Cleft nasal correction is staged, with an interim operation around school age and the final one in mid adolescence.
Approach and materials differ between those stages, with the definitive operation more likely to be open and to use the patient's own cartilage.
Only about one in five teams responded, so the figures represent those who chose to answer.
The authors' own conclusion is that practice varies widely with no agreed standard.

Why this paper matters

Timing and technique in cleft rhinoplasty affect a growing child's face and are decided without an agreed guideline. This survey documents what accredited teams actually do and how much they differ. It does not compare outcomes between the practices reported.

Terms

Secondary cleft rhinoplasty: nasal surgery after the initial repair in infancy.
Intermediate rhinoplasty: an interim operation during childhood.
Definitive rhinoplasty: the final nasal operation, once growth is complete.
Closed approach: surgery through incisions inside the nose only.
Autologous graft: tissue taken from the patient's own body.
Response rate: the proportion of those surveyed who replied.

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

Abstract

Unlabelled: Patients with cleft lip often undergo a primary rhinoplasty at the time of lip repair, and further surgical correction with secondary cleft rhinoplasty (SCR) is often warranted for improved form and function. The purpose of this study was to better elucidate current practice patterns and trends for how SCR is performed in the United States.

Methods: We administered a survey to team surgeons affiliated with cleft lip and palate care teams approved by the American Cleft Palate Craniofacial Association (ACPA).

Results: We received responses from 40 ACPA-approved teams for a response rate of 20.7%, with 59 total ACPA team surgeons completing the survey. 88.1% of surgeons perform intermediate cleft rhinoplasties. Among those who perform an intermediate cleft rhinoplasty, the mean age at which they would first consider the procedure is 5.83±2.66 years. The mean age for consideration of definitive cleft rhinoplasty was 15.86 ± 1.73 years. In both unilateral and bilateral cleft lips, a closed approach was more common in intermediate rhinoplasty, while an open approach was more common in definitive rhinoplasty (P < 0.001). The use of autologous grafts was more common in definitive rhinoplasty (P < 0.001), with 65% of respondents utilizing autologous grafts in greater than three-quarters of their procedures.

Conclusions: When comparing intermediate with definitive cleft rhinoplasty, we found significant increase in the use of open techniques, autologous cartilage use for augmentation of the nasal tip, dorsal nasal support, and columellar sup- port. The considerable variability among surgeons highlights the lack of consensus regarding SCR.

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