Cleft Lip Repair: Trends of Nasoalveolar Molding, Concomitant Tip Rhinoplasty and/or Septoplasty, and Revisions Using a National Database Study.

[BACKGROUND] The literature is limited regarding the prevalence of nasoalveolar molding (NAM), primary tip rhinoplasty and/or septoplasty, and revision surgery. Our study aims to evaluate national utilization rates of NAM, primary tip rhinoplasty or septoplasty, and lip revisions using an international database.

[METHODS] A retrospective review was performed on TriNetX, a de-identified claims database. Patients younger than 1 year with a primary unilateral or bilateral cleft lip repair from 2000 to 2023 were included. Procedures, including NAM, initial repair, primary tip rhinoplasty, and/or septo-rhinoplasty, and any subsequent cleft lip revision surgery, were identified by billed Current Procedural Terminology (CPT) codes and date of occurrence. Patient demographic data were extracted and analyzed through TriNetX.

[RESULTS] From 2000 to 2023, 5642 patients underwent cleft lip repair; 78% had unilateral cleft lip repair, 22% had bilateral cleft lip repair, and 48% concurrent tip rhinoplasty and/or septoplasty. A minority of patients (2.3%) underwent preoperative NAM. There was a high rate of cleft lip revisions at 9.7%. Prevalence of concomitant primary tip rhinoplasty and/or septoplasty increased from 14% to 59% from 2000 to 2023 (R2=0.86, P<0.001). NAM utilization progressively increased in the second decade of the study, reaching 2.2% by 2023.

[CONCLUSION] This study highlights the dynamic evolution of cleft care. Advancing surgical techniques may contribute to increased correction of cleft lip nasal deformity at the time of primary cleft lip repair, improved initial repair, and subsequent decrease in revision rates. Over the time period of the study, we have seen increased utilization of NAM.