Effectiveness and Outcomes of Primary Rhinoplasty in Cleft Lip Surgery: A Systematic Review and Meta-Analysis.

[BACKGROUND] Cleft lip/palate deformity affects the lips, nose, and nostrils and is one of the most common congenital orofacial anomalies globally. Over the past half a century, a longstanding debate has taken place on whether nasal deformity should be corrected at the same time as cleft surgery. The review aims to evaluate the outcomes, effectiveness, and safety of primary rhinoplasty in cleft lip patients.

[METHODS] The authors acquired relevant records up to June 2024 from PubMed, Scopus, Web of Science, and Cochrane Library. Using RevMan 5.4.1 and OpenMeta v5.26.14 software, the authors examined the effectiveness of surgery, the need for revision surgeries, and different anthropometric outcomes. A random effects model was used across all outcomes due to heterogeneity.

[RESULTS] After screening 4337 records from 4 databases, the authors included 65 articles in the review, with 41 providing sufficient data for analysis. Primary rhinoplasty with unilateral cleft surgery was significantly more effective than cleft repair alone (RR: 1.87, P <0.0001). Bilateral cleft cases had significantly wider nasal widths and lower nasal tip projections compared with controls, whereas unilateral cases showed no significant differences. The nasal tip and nasolabial angles were significantly wider in bilateral cleft cases. The surgery achieved its goals in 73.6% of unilateral and 88% of bilateral cases, with only 14% requiring additional surgeries for unilateral deformities.

[CONCLUSION] Primary rhinoplasty is effective, with 73.6% success in unilateral and 88% in bilateral cases, reducing secondary surgeries. Bilateral cleft cases show significant differences in nasal measurements, unlike unilateral cases. Long-term follow-up confirms stable nasal symmetry with minor complications. Future research should standardize techniques for optimal outcomes.