Application of Postoperative Nasal Retainers in Primary Cleft Cheilorhinoplasty: A Review Providing Practical Tips and Tricks

Abstract

Nowadays, primary cleft lip repair is simultaneously performed with rhinoplasty. Postoperative stenosis and relapse of the nose are one of the major complications of this surgery. To tackle these issues, nasal stents can be placed following the surgical correction. Several studies describe the value of postoperative nasal stents in maintaining postoperative nasal morphology and facilitating nasal breathing. Nonetheless, data of their practical use is lacking. Detailed information about the type of retainer, duration of usage, follow-up, device fixation, and complications is currently unknown. The authors conducted a review to summarize the practical information regarding the use of postoperative nostril retainers in primary cleft cheilorhinoplasty. In total 19 articles were included, which showed substantial heterogeneity. Our results reveal that the prefabricated silicone stent has been studied most often and was left in place for an average duration of 6 months. Changing its size upon follow-up is recommended in a minority of cases. Approximately one third of the included articles described various types of custom-made stents with differing duration of use. It appears that stent-retention is by far the most challenging issue, as splint loss and skin irritation from adhesive tapes are the most frequently reported complications. To conclude, despite the lack of consensus on its use, several studies describe the value of postoperative nasal stents in maintaining nasal morphology after primary cleft cheilorhinoplasty. Practical information on its use is presented for the health care provider. Future prospective studies are needed to obtain high-level evidence regarding its use.

Keywords: Cheilorhinoplasty; cleft lip and nose; nasal retainer; primary surgery; review.