Many patients who have undergone a cleft rhinoplasty procedure have interest in a secondary procedure, according to findings presented at the 2024 Triological Society Combined Sections Meeting.
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May 2024The findings of this small, survey-based study suggest that providers should keep in touch with patients about their surgical options as they age, researchers said. “These patients should be offered revision procedures or secondary cleft rhinoplasty where appropriate,” said Nicole DeSisto, BA, the presenter and a fourth-year medical student at Texas A&M University in College Station, who was previously a research fellow at Vanderbilt University in Nashville, where the study was conducted. She worked on the study with Scott Stephan, MD, associate professor of otolaryngology–head and neck surgery at Vanderbilt.
These patients should be offered revision procedures or secondary cleft rhinoplasty where appropriate. — Nicole DeSisto, BA
Craniofacial clefts are one of the most common craniofacial anomalies, seen in one of 700 live births in the U.S. annually, DeSisto said. Patients are usually seen by a multi-disciplinary team and go through a structured surgical timeline that includes primary surgical management, velopharyngeal surgery, alveolar bone grafting, and orthognathic surgery. Cleft rhinoplasty also is often built into this timeline as either a primary procedure performed at the time of the initial cleft repair, or a secondary procedure following craniofacial maturation, she added.
“We know that these patients also have a frequent incidence of nasal obstruction and cosmetic concerns that can have a significant impact on their social interactions as well as overall patient quality of life,” DeSisto said. “In our experience, many of these patients are typically lost to follow-up prior to definitive secondary surgical intervention.”
In the study, researchers surveyed the long-term cleft population at Vanderbilt University to reassess nasal obstruction and cosmetic concerns and gauge future interest in secondary cleft rhinoplasty procedures. Patients and their primary caregivers completed surveys by phone and were scored on the Nasal Obstruction and Septoplasty Effectiveness (NOSE) scale and on the nose, nostril, school, and social subdomains of the CLEFT-Q, a patient-reported outcome measure. Eighteen patients, aged 12 to 18 years and an average age of 14, and their caregivers completed all of the surveys and were included in the final analysis.
The median NOSE score of this cohort was 35 out of 100, indicating moderate nasal obstruction. The researchers also observed declines in scores in the cleft lip and palate group on the nose and nostril CLEFT-Q subdomains, along with scores that indicated moderate dysfunction in the school and social subdomains, DeSisto said.
Among patients who had undergone previous rhinoplasty, researchers found significant reduction in the nostril cosmetic subdomain of the CLEFT-Q, and some reduction in the nose cosmetic subdomain, although this was not found to be significant.
Seven of the 18 patients had undergone previous cleft rhinoplasty, and eight expressed interest in future procedures, primarily for both cosmetic and functional purposes.
Although the power of the study was limited due to its small sample size, the investigators noted several important points to draw from the findings, DeSisto said. “We’ve redemonstrated the high incidence of moderate nasal obstruction and lower health-related quality of life in this patient cohort overall, and we also discovered this frequent interest in secondary cleft rhinoplasty revision procedures,” she said. “We think this highlights a couple of things, one just being the importance of frequent use of patient-reported outcome measures in this patient cohort, as well as the importance of the potential for reengaging older patients who may have been previously lost to follow-up following cleft management.”
Thomas R. Collins is a freelance medical writer based in Florida.