Long-Term Outcome of Primary Rhinoplasty with Overcorrection in Patients with Unilateral Cleft Lip: Avoiding Intermediate Rhinoplasty

Overview

There is no agreement on when or how to correct the nasal deformity that comes with a one sided cleft lip. The authors followed patients who had primary rhinoplasty with overcorrection using the Tajima technique, done by a single surgeon between 2000 and 2005, and assessed them once facial growth was complete. Results were compared with cleft patients who had primary rhinoplasty without overcorrection and with people born without clefts.

Sections of note

• Design: retrospective comparative study of consecutive nonsyndromic patients, single surgeon. Level of evidence therapeutic III.
• Groups: 103 patients treated with Tajima overcorrection, 30 cleft patients treated without it, 27 noncleft individuals.
• Outcomes: two FACE-Q satisfaction scales plus photogrammetric measurement of nostril height, nostril width, nostril area, alar height and alar width.
• The Tajima group differed significantly from the non-Tajima group on every parameter except nostril area, all p less than 0.001, with values closer to the noncleft group.
• FACE-Q nose and nostril satisfaction scores did not differ significantly between the Tajima group and the noncleft group, all p greater than 0.05.
• Stated conclusion: overcorrection at the primary operation removed the need for an intermediate rhinoplasty.

What it means for a patient

• Deliberately overcorrecting the cleft nose at the first operation is reported to leave a more symmetric nose once growth is finished.
• Satisfaction scores in the overcorrected group matched those of people born without a cleft, a demanding comparison to meet.
• Avoiding an intermediate operation means one fewer surgery in the treatment sequence.
• Limits: retrospective, one surgeon, unequal group sizes, no randomization, and measurement from photographs rather than three dimensional imaging.

Why this paper matters

Cleft nasal deformity has traditionally been treated in stages as the face grows, each stage carrying scarring and anesthesia. Long term data extending to skeletal maturity is rare here. Whether these results transfer to other surgeons and cleft severities is unanswered.

Terms

• Unilateral cleft lip: a birth difference where the lip did not join on one side.
• Overcorrection: deliberately correcting past the target, anticipating later relapse.
• Tajima technique: a named method of cleft nasal repair using a reverse U incision.
• Intermediate rhinoplasty: a corrective nose operation done during childhood.
• Photogrammetric analysis: measurement taken from standardized photographs.