Deformity and revision rates after secondary unilateral cleft lip rhinoplasty with different cartilage grafts: A systematic review and meta-analysis

Abstract

Secondary unilateral cleft lip (UCL) rhinoplasty is challenging for plastic surgeons, and therefore there are still risks of complications and the need for revision. In this study, we performed a systematic review and meta-analysis for patients undergoing secondary UCL rhinoplasty to compare deformity and revision rates of rhinoplasty with different cartilage. The Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for relevant literature from the database inception to October 2022. Patients aged over 12 years old who underwent secondary UCL rhinoplasty using cartilage grafts to project the nasal tip were included. Random-effects meta-analysis, subgroup analysis, the Egger’s test for funnel-plot asymmetry, and meta-regression were performed. Twenty-three studies were included and these studies comprised 842 participants, of whom 362 received septal cartilage grafts, 348 received costal cartilage grafts, and 132 received conchal cartilage grafts. When nasal septal, costal, and conchal cartilage grafts were compared, no significant difference (P = 0.755) in deformity rate (0.7%, 95% CI 0%–2.4%) was found, while there was a significant difference (P < 0.001) in revision rate (6.7%, 95% CI 0.8%–16.1%). The pooled rate of deformity was considerably low in secondary UCL rhinoplasty using cartilage grafts, while there was a relatively higher incidence of revision. Nevertheless, the current systematic review has limitations due to sample heterogeneity and limited sample size, necessitating future studies with larger patient cohorts, longer-term follow-up, and standardized surgical procedures to provide stronger evidence for clinical practice and improved patient outcomes.