Primary Cleft Rhinoplasty: A Systematic Review of Results, Growth Restriction, and Avoiding Secondary Rhinoplasty

Overview

Performing rhinoplasty during the repair of a one sided cleft lip remains debated because early nasal surgery may affect later nasal and upper jaw development. This systematic review, following PRISMA guidelines, set out to determine the volume and quality of evidence for and against the practice. PubMed and EMBASE were searched and studies screened by title and abstract.

Sections of note

• Systematic review; 25 articles included after applying inclusion and exclusion criteria.
• Excluded were studies with many syndromic patients, case reports, editorials, letters, reviews, bilateral cleft only studies and non English publications.
• Ten articles assessed results subjectively and all supported primary rhinoplasty at the time of lip repair.
• Sixteen articles assessed results objectively, with 15 supporting the practice.
• Eight of nine studies evaluating nasal growth over time found no restriction in nasal development.
• Five studies with at least 6 years of follow up reported that the proportion of patients avoiding revision rhinoplasty ranged from 43 to 100 percent.
• The authors note significant risks of bias in the majority of studies.

What it means for a patient

• The main concern about operating on the nose during infant lip repair is that it might stunt later growth, and the reviewed evidence largely does not support that concern.
• Between 43 and 100 percent of patients avoided a later revision, which is a very wide range across the five longer studies.
• The authors themselves flag substantial risk of bias across the included studies.
• Only English language publications on one sided clefts were included.

Why this paper matters

Whether to correct the nose during infant lip repair is a decision made for nearly every child with a cleft, and the growth concern has shaped practice for decades. This review assembles the evidence and finds it favours doing so. The quality of that evidence is the acknowledged weakness.

Terms

• Primary cleft rhinoplasty: nasal correction performed at the same time as the infant lip repair.
• Secondary rhinoplasty: a further nasal operation later in life.
• Unilateral cleft lip: a cleft affecting one side of the lip.
• Growth restriction: stunted development of a structure following early surgery.
• Risk of bias: features of a study that may distort its result.
• PRISMA: a standard method for reporting systematic reviews.