Long-term outcome of cleft lip nasal reconstruction in childhood

This study documents the pattern of unilateral cleft lip nasal reconstructi on in the practice of one surgeon at a tertiary cleft center, evaluating th e long-term appearance outcome of single-operation unilateral cleft lip nas al reconstruction in childhood. A retrospective medical record review was performed for all patients with a diagnosis of unilateral cleft lip and age greater than 15 years. Operative notes were reviewed, recording 15 variables identifying specific rhinoplas tic maneuvers. Nasal appearance outcome analysis was performed for all pati ents who underwent only one nasal surgery before 12 years of age (n = 19). Standard frontal whole face photographic images were presented as opposing pairs in a looseleaf binder to two panels, 1 of 10 lay persons and 1 of 10 plastic surgeons. Each pair consisted of photographs of the same patient at different ages in one of three combinations: preoperative-perioperative, p erioperative-longest postoperative, or preoperative-longest postoperative. Participants were asked to compare the appearance of the noses in the two p hotographs and as sign a rating based on a 5-point Likert scale. Statistica l analyses were performed on the data collected in the aesthetic analysis. The effect of surgery upon nasal appearance was assessed by comparing the p reoperative and perioperative photographs. The effect of growth was assesse d by comparing the perioperative and long-term postoperative photographs. T he combined effect of surgery and growth was assessed by comparing the preo perative and long-term postoperative photographs. The data were assessed by lay and professional evaluators, together and separately, to determine whe ther differences existed. The majority of patients did not undergo revisional nasal surgery, whereas those who did usually had one nasal operation. Most revisional nasal surger y was performed in conjunction with other cleft-related secondary surgery. A majority of lay and professional evaluators perceived revisional nasal su rgery as improving nasal appearance in the short-term and to a lesser degre e in the long-term, as compared with the preoperative state. Evaluations of revisional nasal surgery are generally constant between the short-term and long-term postoperative images. Lay evaluations may be contaminated by a g eneral decline ill attractiveness with aging. Patient preference should be a major factor in the decision for nasal revis ion surgery. Multiple means of assessing nasal appearance outcome need to b e used to validate results. Nasal appearance outcomes need to be correlated with outcomes with respect to nasal morphology and function as well as pat ient and parent satisfaction.