Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting.

BACKGROUND: Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon.

OBJECTIVES: The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient's self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients' age; (3) patients' gender; and (4) panel perceptions.

METHODS: Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient's subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P≤0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively.

RESULTS: The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings (P>0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics (P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients' age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction.

CONCLUSIONS: Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.