Bilateral Cleft Lip Repair With and Without Primary Rhinoplasty: Comparing Two-Year Aesthetic and Anthropometric Outcomes

Abstract

Objective

To compare aesthetic outcomes in patients with bilateral cleft lip treated with concurrent primary rhinoplasty (PR) versus non-primary rhinoplasty (NPR), using layperson and anthropometric assessments.

Design

Retrospective review of patients undergoing bilateral cleft lip repair between 2008 and 2024.

Setting

Single tertiary care institution.

Patients/Participants

Seventy-five children (mean age = 6.1 ± 3.6 months) who underwent bilateral cleft lip repair.

Interventions

PR performed in 55 patients (73.3%) and non-PR in 20 patients (26.7%). Preoperative cleft severity was graded with the Bilateral Cleft Lip Severity Index (BCLSI; grades 1-3). Presurgical nasoalveolar molding (NAM) and nasal stenting were also evaluated.

Main Outcome Measures

Layperson perception surveys (pairwise comparison and Likert scale) and anthropometric analyses of nasal appearance.

Results

Lower BCLSI scores predicted superior aesthetic ratings. Lip adhesion after NAM failure correlated with inferior ratings (p < .001). Overall, PR did not yield superior nasal appearance compared with NPR. In subgroup analysis, PR patients in the BCLSI3 group had higher layperson scores (p = .036). PR with nasal stenting ≥21 days was associated with greater Goode's ratio (p < .001). Increased columellar-labial angle correlated with inferior nasal appearance (p = .029).

Conclusions

These data highlight the impact of presurgical NAM on oronasal outcomes and preoperative cleft severity to guide personalized surgical approaches in this patient population.