Clinical Practice Patterns and Evidence-Based Medicine in Secondary Cleft Rhinoplasty: A 14-Year Review of Maintenance of Certification Tracer Data From the American Board of Plastic Surgery

• Published in: The Cleft palate-craniofacial journal 2021-09, Vol.58 (9), p.1110-1120
• Main Authors: Rokni, Alex M., Kearney, Aaron M., Brandt, Keith E., Gosain, Arun K.
• Format: Article
• Language: English
• Subjects: Airway management; Birth defects; Cartilage; Children & youth; Dentistry; Evidence-based medicine; Plastic surgery; Rhinoplasty
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1177/1055665620977367

Objective: To evaluate evolving practice patterns in secondary cleft rhinoplasty. Design: Retrospective review of data submitted during Maintenance of Certification (MOC). Setting: Evaluation of MOC data from the American Board of Plastic Surgery. Participants: Tracer data for secondary cleft rhinoplasty were reviewed from August 2006 through March 2020, and the data subdivided from 20062012 and 20132020 to evaluate changes in practice patterns. Interventions: Practice patterns in tracer data were compared to those from evidence-based medicine (EBM) literature over this time period. Main Outcome Measures: Practice patterns were compared to EBM trends during the study period. Results: A total of 90 cases of secondary cleft rhinoplasty were identified. The average age at operation was 13 years (range 4-77). Cumulative data demonstrated 61% to present with nasal airway obstruction and 21% to have undergone primary nasal correction at the time of cleft lip repair; 72% of patients experienced no complications, with the most common complications being asymmetry (10%) and vertical asymmetry of alar dome position (6%). Cartilage graft was used in 68% of cases, with 32% employing septal cartilage. Change in practice patterns between 2006 to 2012 and 2013 to 2020 demonstrated increase in dorsal nasal surgery (26% vs 43%, P = .034), use of osteotomies (14% vs 38%, P = .010), septal resection and/or straightening (26% vs 48%, P = .034), and turbinate reduction (8% vs 30%, P = .007). Conclusions: These tracer data provide long-term data by which to evaluate evolving practice patterns for secondary cleft rhinoplasty. When evaluated relative to EBM literature, future research to further improve outcomes can be better directed.