D50. A Single Center’s 18-year Experience Of 1170 Rhinoplasties among 1007 Patients with Cleft Lip Nasal Deformity

PURPOSE: The cleft lip nasal deformity is challenging both aesthetically and functionally. This study examines nasal outcomes of cleft rhinoplasties. METHODS: We performed a retrospective cohort study of patients who underwent rhinoplasty for cleft lip nasal deformity from 2006-2023. Primary outcomes were surgical burden and perioperative complications. Rhinoplasties were grouped into primary, occurring concurrent to definitive lip repair; intermediate, between lip repair and age 12; and definitive, at age 12 or older. RESULTS: Among 1170 rhinoplasties, 497 (42%) were primary, 364 (31%) intermediate, and 309 (26%) definitive. Mean age at surgery were 0.45±0.29, 7.8±1.7, and 17.3±4.2 years, respectively. Intermediate rhinoplasties utilized the following: no graft/implant, 40%; iliac crest cartilage graft, 44%; ear cartilage, 10%; resorbable plate, 5%. Use of iliac crest graft predicted fewer subsequent rhinoplasties (-0.168, SE 0.061, p=0.006). The proportion of iliac crest graft intermediate rhinoplasties increased over time (0.036, SE 0.007, p<0.001). Graft/implant use in definitive rhinoplasty was distributed as follows: nasal, 47%; no graft/implant, 21%; rib, 10%; ear, 12%; resorbable plate, 5%; iliac crest, 4%; and cadaver, 0.4%. Rib graft rhinoplasties had more perioperative complications (28% versus 2%, p<0.001). The cohort with follow up to skeletal maturity (n=89) had a median of 2 (range 1-8) lifetime rhinoplasties, with no difference in number of subsequent rhinoplasties between cohorts who did/did not undergo primary rhinoplasty (1.8 versus 1.8, p=0.996). Mean follow-up period was 8.4±6.0 years. CONCLUSION: Improved understanding of cleft rhinoplasty outcomes may alleviate some of the functional, aesthetic, and psychosocial challenges among patients with cleft nasal deformities.