SP48. Open Vs. Closed Primary Cleft Rhinoplasty

PURPOSE: Patients with cleft lip and palate (CLAP) often have substantial nasal deformity. These patients require a primary rhinoplasty a few months after birth. This can be completed using either an open or closed approach as there is no consensus in the literature regarding which approach is more effective. Despite initial rhinoplasty, many patients with CLAP undergo intermediate and/or definitive rhinoplasty in early adolescence, demonstrating a need for improved primary rhinoplasty outcomes. The goal of this project is to compare nostril asymmetry in patients with CLAP that underwent closed or open primary rhinoplasty at our institution. METHODS: We conducted prospective enrollment of patients with unilateral complete CLAP at our single institution. Inclusion criteria consisted of patients less than 17 years of age, no intermediate or secondary rhinoplasty, and with unilateral complete CLAP. Each patient that qualified and consented for the study had photos of their nostrils taken. Maximum nostril height and width were measured. All measures were expressed as ratios with respect to the unaffected nostril. A ratio of 1 represents perfect symmetry in that nostril measurement. Chart review was performed to obtain demographic information and past surgical history. Open rhinoplasty approach was characterized as utilizing a rim incision and placement of interdomal sutures. RESULTS: 29 patients satisfied the inclusion criteria, 14 in the open rhinoplasty and 15 in the closed rhinoplasty group. Mean age of the entire cohort was 8.1 years. Group comparison analysis was conducted via two-sided unpaired t-test. Both groups had an average nostril height ratio less than 1 and an average nostril width ratio greater than 1. There was no significant difference in nostril height ratio for open vs. closed technique (0.87 vs. 0.88, p=.90). There was no significant difference in nostril width ratio for open vs. closed technique (1.14 vs. 1.14, p=.99). Five patients (33%) in the closed rhinoplasty cohort underwent an intermediate rhinoplasty compared to only two (14%) patients in the open rhinoplasty cohort. CONCLUSION: Reduction of cleft nasal deformity can be performed using both open and closed techniques. Both techniques had residual cleft nasal deformity, characterized by increased width and decreased height in ipsilateral nostril. Although both cohorts had similar measurements, the closed rhinoplasty group had a higher intermediate rhinoplasty rate. Open rhinoplasty technique may decrease the need for intermediate rhinoplasty. We are continuing to prospectively enroll patients in this study to increase our sample size.