Longitudinal Anatomic Analysis of Primary Cleft Lip Rhinoplasty Outcomes

Overview

A one sided cleft lip comes with a matching nasal deformity that causes both breathing and appearance problems. The authors measured how nostril symmetry changed over time after primary endonasal cleft rhinoplasty performed at the same time as the lip repair. They reviewed charts of infants undergoing unilateral cleft lip repair and analyzed standardized photographs of the nostrils and nostril rims with ImageJ software.

Sections of note

• Design: retrospective chart review with photographic measurement, analyzed by mixed effect models.
• 22 patients, 46 percent female, mostly left sided clefts. Mean age at lip repair 3.9 months, median 3.0, range 2 to 12.
• Symmetry ratio scale: zero is perfect symmetry and negative values indicate overcorrection.
• Mean alar symmetry ratio was 0.099 before surgery and minus 0.0012 immediately after.
• Ratios at 1, 2 to 4, 5 to 7, 8 to 12, 13 to 24 and 25 or more months were 0.026, 0.050, 0.046, 0.052, 0.049 and 0.052.
• Interpretation: symmetry regressed during the first four months and then stabilized past two years.

What it means for a patient

• Overcorrecting at the time of lip repair does not hold completely. Some of the correction is lost in the first months as the tissue settles.
• What is lost appears to be lost early. After about four months the measurements stayed flat out to more than two years.
• The end position, around 0.05, is roughly half the starting asymmetry of 0.099, so about half the original difference remained.
• Limits: 22 patients, retrospective, single center, no comparison group without overcorrection, and symmetry measured on two dimensional photographs.

Why this paper matters

Surgeons who overcorrect the cleft nose do so expecting relapse, but how much relapse and over what period has rarely been measured. This study supplies a time course showing the relapse window closes at about four months. What it does not answer is how much overcorrection is the right amount, or how these noses look at skeletal maturity.

Terms

• Unilateral cleft lip: a birth difference where the lip did not join on one side.
• Primary cleft rhinoplasty: nasal correction performed at the same time as the first lip repair.
• Endonasal: performed through incisions inside the nose, with no external scar.
• Alar symmetry ratio: a photographic measure comparing the two nostril rims.
• Overcorrection: deliberately correcting past the target, anticipating later relapse.