Rhinoseptoplasty in Cleft Lip Palate patients, prospective evaluation

Background: 3D imaging in patients with cleft lip and palate (CL/P) plays an important role in treatment planning. Secondary rhinoplasty allows for more predictable and long-lasting results by providing greater support to the nasal skeleton. Methods: This longitudinal study included 18 patients who underwent secondary rhinoplasty. All were evaluated in two periods (pre- and 12 months after surgery) and underwent: computed tomography (CT), 3D photogrammetry (F3D); responded to the Rhinoplasty Outcomes Evaluation (ROE) and CLEFT-Q questionnaires. Results: Of the 18 patients selected, 67% (n=12) received rib cartilage and 33% (n=6) septum. The ratios evaluated were similar when comparing the two imaging methods separately. However, the two methodologies when compared showed that both pre- and post-operatively, some measurements were different (p<0.05). The use of rib cartilage showed an increase in the volume of the nose divided in half with the cleft side (LF), the rise of the tip and the back in relation to the use of a septum. The LF/LNF ratio (non-cleft side) for the airway showed improvement in symmetry in the postoperative rib surgery (0.98±0.26 versus pre-0.79±0.19; p=0.027) both by photogrammetry and by CT. Those who received rib cartilage showed improvement in postoperative symmetry for the LF/LNF ratio of the sinuous nose (0.99±0.11 versus pre-0.97±0.12; p=0.004) by CT. Regarding nostril area (cm2) (evaluated by CT), rib cartilage provided a ratio close to ideal postoperatively (0.93±0.17 versus pre-1.06±0.19; p=0.029). The scores of the quality questionnaires showed an improvement in postoperative satisfaction (general series or distributed by type of cartilage). Conclusion: F3D and CT, alone, are accurate in helping to identify nasal measurements, however they are not equivalent when compared. Rib cartilage shows a more effective postoperative period, with regard to improving nasal measurements, raising the tip and increasing projection. CLEFT-Q does not measure nasal airway function, however both scales, despite not being equivalent, have similar accuracy.