Secondary cleft nose rhinoplasty: Subjective and objective outcome evaluation

Gaßling, Volker; Koos, Bernd; Birkenfeld, Falk; Wiltfang, Jens; Zimmermann, Corinna

doi:10.1016/j.jcms.2015.08.012

Cited by 24 publications

(16 citation statements)

References 25 publications

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“…29–32 Although secondary rhinoplasty has been shown to be an effective means of improving persistent stigmata of the cleft nasal deformity, efforts to improve primary outcomes might obviate the need for such measures. 33–35 To date, nasoalveolar molding (NAM) and other types of presurgical nasal molding represent our best attempts at optimizing cleft nasal outcomes. 36–38 Long-term follow-up using these techniques has shown a decrease in secondary rhinoplasty and cleft lip revision rates, with resultant decreases in overall healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Hammoudeh

Imahiyerobo

Fan

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:The optimal timing for cleft lip repair has yet to be established. Advances in neonatal anesthesia, along with a growing body of literature, suggesting benefits of earlier cleft lip and nasal repair, have set the stage for a reexamination of current practices.Methods:In this prospective study, cleft lip and nasal repair occurred on average at 34.8 days (13–69 days). Nasal correction was achieved primarily through molding the nasal cartilage without the placement of nasal sutures at the time of repair. A standardized anesthetic protocol aimed at limiting neurotoxicity was utilized in all cases. Anesthetic and postoperative complications were assessed. A 3-dimensional nasal analysis compared pre- and postoperative nasal symmetry for unilateral clefts. Surveys assessed familial response to repair.Results:Thirty-two patients were included (27 unilateral and 5 bilateral clefts). In this study, the overall complication rate was 3.1%. Anthropometric measurements taken from 3-dimensional-image models showed statistically significant improvement in ratios of nostril height (preoperative mean, 0.59; postoperative mean, 0.80), nasal base width (preoperative mean, 1.96; postoperative mean, 1.12), columella length (preoperative mean, 0.62; postoperative mean, 0.89; and columella angle (preoperative mean, 30.73; postoperative mean, 9.1). Survey data indicated that families uniformly preferred earlier repair.Conclusions:We present evidence that early cleft lip and nasal repair can be performed safely and is effective at improving nasal symmetry without the placement of any nasal sutures. Utilization of this protocol has the potential to be a paradigm shift in the treatment of cleft lip and nasal deformity.

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Section: Introductionmentioning

confidence: 99%

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Hammoudeh

Imahiyerobo

Fan

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…They too, stressed the importance of factors other than technical skill to be important for patient satisfaction, like positive reactions of their environment after rhinoplasty and the communication skills of the surgeon, recognizing the patient’s expectations and provide a realistic prognosis of the expected results. Opposed to the abovementioned findings, Gassling et al (2015) concluded the ROE and AMAI were largely compatible in their study (Table 3). However, they came to this conclusion because the subjective and objective outcomes were descriptively congruent, not because a statistical correlation was performed between the ROE and AMAI scores.…”

Section: Discussionmentioning

confidence: 66%

Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip

Mulder

Mosmuller

Vet

et al. 2019

The Cleft Palate Craniofacial Journal

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Objective: To determine if there is a correlation between objective nasolabial aesthetics assessment using the Cleft Aesthetic Rating Scale (CARS) and patient satisfaction. Design: Retrospective analysis of a generic satisfaction questionnaire and independent assessment by three cleft surgeons of the nasolabial area of these patients on 2D frontal photographs, using the CARS. Setting: The Vrije Universiteit Medical Center and The Academic Center for Dentistry Amsterdam. Patients: Thirty-nine 18-year old patients with a repaired complete or incomplete unilateral cleft lip, with or without a cleft palate, and a completed satisfaction questionnaire. Exclusion criteria were an incomplete questionnaire; a history of facial trauma; and congenital syndromes affecting facial appearance. Main Outcome Measures: The correlation between surgeon evaluation (on a 5-point Likert scale) and patient satisfaction (not, moderately or very satisfied) on nasolabial appearance was assessed using Spearman rho (ρ). Results: There was a negligible correlation between surgeon evaluation and patient satisfaction on nose assessment (ρ = 0.20) and a moderate correlation on lip assessment (ρ = 0.32). Conclusions: Most literature supports this discrepancy between different objective aesthetics evaluation methods and subjective patient-reported outcome measures, suggesting there are factors playing a role in patient satisfaction that are impossible to objectify with assessment methods. Therefore, a strong emphasis should remain on clear communication between the physician and patient regarding their expectations, perception, and satisfaction of surgery results.

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“…Balaji (2016) also provided patients with presurgical profile photographs to aid their memory in completing the presurgery measure, which may have unintentionally further biased results. Two studies based their findings on a single postsurgery measure of satisfaction (Byrne et al, 2014;Gassling et al, 2015). The lack of a presurgery measure severely limits the conclusions that can be drawn from both studies.…”

Section: Use Of Validated Tools To Measure Satisfaction With Appearancementioning

confidence: 99%

The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review

Acum

Mastroyannopoulou

O'Curry

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway. Design: A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery. Results: Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress. Conclusions: Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.

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Secondary cleft nose rhinoplasty: Subjective and objective outcome evaluation

Cited by 24 publications

References 25 publications

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip

The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review

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