A Longitudinal Study of Improvement in Nasal Airway Obstruction after Secondary Cleft Rhinoplasty

Overview

People born with a cleft lip or palate often have a blocked nasal airway, which affects daily life. The authors set out to test whether secondary cleft rhinoplasty, a later corrective nose operation, relieves that blockage. They identified patients operated on at the Children's Hospital of Philadelphia between 2015 and 2021 and compared their Nasal Obstruction Symptom Evaluation scores before and after surgery.

Sections of note

• Design: longitudinal review of patients undergoing secondary cleft rhinoplasty at one hospital, 2015 to 2021. Level of evidence therapeutic IV.
• Blockage before surgery was mild to moderate in severity.
• Three symptom areas improved after surgery: nasal blockage, trouble breathing through the nose, and getting enough air during exertion, each p less than 0.05.
• The overall composite NOSE score improved, p less than 0.05.
• Lateral crural strut grafting was associated with improvement in nasal blockage.
• Alar revision and tip sutures were associated with worsening of specific nasal symptoms.
• Patients who had postoperative nasal stenting reported less trouble breathing than those who did not, p less than 0.05.

What it means for a patient

• Secondary cleft rhinoplasty is reported here to improve breathing symptoms, not only appearance.
• Different steps within the same operation pulled in different directions. Some support grafts helped breathing while some tip and nostril maneuvers were linked to worse symptoms.
• Limits: single center, no control group, symptoms measured only by questionnaire rather than airflow testing, and the abstract gives no patient count or follow up length.

Why this paper matters

Cleft rhinoplasty has usually been judged on appearance and symmetry, with breathing treated as a secondary concern. This study puts numbers on the functional side and links specific surgical maneuvers to symptom change. Which maneuvers cause the worsening, and whether it lasts, is not answered.

Terms

• Cleft lip or palate: a birth difference in which the lip or roof of the mouth did not fully join.
• Secondary cleft rhinoplasty: a later operation to correct the nasal deformity left by a cleft.
• NOSE score: a questionnaire measuring nasal blockage, where higher means worse.
• Lateral crural strut graft: a cartilage strip placed under the nostril rim cartilage to support it.
• Nasal stenting: keeping a small tube or splint in the nostril after surgery to hold shape.