Primary Rhinoplasty for Unilateral Cleft Lip: A Long-Term Cohort Assessment of Aesthetic and Anthropometric Outcomes

<i>Objective</i>The decision to undertake rhinoplasty maneuvers during cleft lip repair remains controversial. Little data compare long-term outcomes with and without primary rhinoplasty (PR). This study compared nasolabial outcomes in cohorts with unilateral cleft lip (UCL) treated with and without PR at the Children's Hospital of Philadelphia using standardized aesthetic and anthropometric assessments.<i>Design</i>Retrospective cohort study.<i>Setting</i>Tertiary care pediatric hospital.<i>Patients/Participants</i>Patients who underwent lip repair for UCL.<i>Interventions</i>Cleft lip repair with and without PR.<i>Main Outcome Measure(s)</i>Anthropometric analyses and crowdsourced aesthetic assessments using Americleft nasolabial appearance reference scales and pairwise comparisons.<i>Results</i>Among 208 patients, 155 (74.5%) and 53 (25.5%) underwent lip repair with and without PR at 4.5 ± 1.1 months. Primary rhinoplasty (β = 0.345, <i>P</i> = .037) and a lower Cleft Lip Severity Index (β = -0.341, <i>P</i> < .001) predicted superior pairwise rank at 4.9 ± 1.9 years of age. History of PR predicted decreased columellar deviation angle (CDA) (β = -2.375, <i>P</i> = .019) and improved nostril symmetry (β = 0.111, <i>P</i> = .038). Increased columellar-labial angle (<i>r</i> = 0.27, <i>P</i> = .002), improved nostril symmetry (<i>r</i> = -0.23, <i>P</i> = .01), and decreased CDA (<i>r</i> = -0.45, <i>P</i> < .001) correlated with superior ratings. Patients with ˂20 days of postoperative nasal stenting had inferior lateral ratings (2.4 ± 0.6 vs 2.1 ± 0.5, <i>P</i> = .005). Those who underwent surgery at ˂5.3 months had inferior nasal projection (Goode's ratio 0.56 ± 0.09 vs 0.62 ± 0.08, <i>P</i> = .006).<i>Conclusions</i>Primary rhinoplasty for UCL offers superior aesthetic results in early childhood by layperson and anthropometric assessments. Specific improved characteristics from PR-CDA and nostril symmetry-most greatly influence layperson perception of nasal appearance. Older age at surgery predicted increased nasal projection, while prolonged nasal stenting predicted superior profile appearance.