Evidence-based medicine: The cleft lip nasal deformity

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the components of unilateral and bilateral secondary cleft lip nasal deformity. 2. Discuss current methods of assessing the deformity and outcomes. 3. Discuss primary treatment options including the use of preoperative orthopedics, nasal molding techniques, and the primary cleft rhinoplasty. 4. Design a treatment plan for cleft patients that will optimize the outcome of nasal appearance and function. 5. Discuss the evidence regarding outcomes of current practices, and describe areas where more research is needed. SUMMARY: This is the third Maintenance of Certification article on the secondary cleft lip nose deformity. In the first article, Guyuron defined the deformities and described techniques for the definitive (adult) rhinoplasty. The second article, by Zbar and Canady, presented evidence regarding the assessment, surgical treatment, and outcomes from the literature published between 1999 and 2009. In this article, the authors summarize important points from the first two articles and then concentrate on the evidence for the following topics: (1) methods currently used in evaluating the severity of the deformities; (2) methods used in evaluating outcomes of different treatments; (3) benefits of rhinoplasty performed at the time of the lip repair and evidence for the effect of rhinoplasties performed after infancy but before maturity; (4) presurgical orthopedics and nasoalveolar molding; (5) common surgical techniques used in primary cleft rhinoplasties; and (6) impact of the nasal deformity on quality of life. Overall, there is little high-level evidence regarding the outcomes of cleft nasal deformity treatment, leaving much room for future study.