Long-Term Surgical Outcomes of Primary Rhinoplasty

Objective To examine the impact of primary rhinoplasty on subsequent rhinoplasties for patients with cleft lip nasal deformity.Design Retrospective cohort study.Setting Tertiary care pediatric hospital.Patients/Participants Individuals who underwent definitive cleft lip repair at our institution from 2000 to 2006 with a current age of 18 or older.Main Outcome Measures Number and timing of subsequent rhinoplasties.Results Among 199 individuals, 94 (47.2%) underwent primary rhinoplasty. Follow-up was 15.0 +/- 4.8 years in the PR cohort and 15.0 +/- 5.1 years in the NPR cohort (p = 0.993). In bilateral cleft lip, interdomal suture predicted fewer subsequent rhinoplasties (beta=-0.310, p = 0.033), while history of primary rhinoplasty predicted greater age at subsequent rhinoplasty (beta=1.800, p = 0.040). Among individuals with follow-up beyond age 18, intranasal stenting predicted fewer subsequent rhinoplasties (beta=-0.609, p = 0.015). Most underwent subsequent nasal correction aside from 7 (19.4%) and 9 (20.9%) in the PR and NPR cohorts, respectively (p = 0.536). There was no difference in mean subsequent rhinoplasties between cohorts (1.1 +/- 0.8 versus 1.3 +/- 1.1, p = 0.284). Individuals with complete cleft lip underwent more lifetime rhinoplasties (1.9 +/- 1.0 versus 1.2 +/- 1.2, p = 0.007).Conclusions Primary rhinoplasty with interdomal tip sutures in bilateral cleft lip was associated with fewer subsequent rhinoplasties. Primary rhinoplasty may delay subsequent nasal correction, though most who underwent primary rhinoplasty ultimately required nasal correction later in childhood. Postoperative nasal stenting may provide longer-term nasal benefits and should be considered at time of definitive cleft lip repair.