D64. What Matters in Primary Cleft Rhinoplasty: Anthropometric, Aesthetic, and Patient-Reported Outcomes in 482 Patients

PURPOSE: Primary rhinoplasty (PR) at the time of cleft lip repair utilizes multiple maneuvers to correct nasal dysmorphology, aiming to improve nasal appearance. This study assessed anthropometric, aesthetic, and patient-reported outcomes (PROs) after PR. METHODS: Among 482 patients who underwent lip repair at our institution from 2008-2024, 319 (66%) underwent PR. Surgical maneuvers included septal repositioning, nasal floor closure and alar base repositioning, lateral cartilage dissection, and suture plication. Those with PR and pre- and immediate post-operative photographs underwent anthropometric analyses, those with photographs over 1.5 months after lip repair underwent aesthetic analyses, those 8-13 years old with CLEFT-Q responses underwent PRO analyses, and those 18+ underwent long-term analyses. RESULTS: Multiple anthropometric ratios are normalized pre- to post-operatively through PR: nostril width (1.95±0.63 vs. 0.96±0.15), base width (1.75±0.50 vs. 0.99±0.14), and alar height (0.82±0.17 vs. 1.02±0.16) (p<0.05). At 1 year, an average 20% relapse of nostril width (1.15±0.23 vs. 0.96±0.15), base width (1.16±0.22 vs. 0.99±0.14), and alar height (0.88±0.07 vs. 1.02±0.16) was noted (n=29, p<0.05). At 5 years, PR (β=0.345) predicted superior pairwise rank as judged by laypersons and improvement in columellar deviation angle (β=-2.375) and nostril symmetry (β=0.111) (n=208, p<0.05). At 8-13 years, CLEFT-Q Nose scores were significantly higher in PR versus lip repair only (75 vs. 57, p<0.05) among patients with intermediate rhinoplasty (n=45/109). CONCLUSION: Primary cleft rhinoplasty conveys lasting improvements in nasal symmetry and appearance. An average 20% relapse from on-table correction manifests at 1 year and may be countered with overcorrection or nasal stenting.