Bilateral Cleft Lip Severity Index in primary cleft rhinoplasty: Correlation with anthropometric outcomes and layperson perception.

[BACKGROUND] The Bilateral Cleft Lip Severity Index (BCLSI) was developed to predict outcomes among patients who underwent bilateral cleft lip (CL) repair. However, its utility among cleft patients undergoing bilateral repair with primary rhinoplasty (PR) has not been studied. Here, we assess whether the BCLSI predicts nasal anthropometric and aesthetic outcomes in patients who had PR at the time of bilateral CL repair.

[METHODS] A retrospective review was performed of all children who underwent bilateral CL repair from 2008 to 2023 at our institution. Preoperative photographs were graded using the BCLSI (grades 1-3, 1 being least severe) and anthropometric analyses performed. Crowdsourcing surveys utilized pairwise comparison or Likert scale ratings of nasal appearance.

[RESULTS] 55 patients met inclusion criteria and were stratified by BCLSI severity: Grade 1, 11 (20.0%); Grade 2, 17 (30.9%); and Grade 3, 27 (49.1%). Postoperative columellar-labial angle (CLA) was 117.7°±8.8°, 127.3°±9.6°, 133.4°±12.4° in patients with BCLSI of 1, 2, and 3, respectively (p<0.001). Patients with BCLSI 1 received the most favorable layperson evaluations, while those with BCLSI 3 received the least favorable assessments across pairwise rank-derived coefficients (p=0.017) and composite ratings (p=0.014) independent of age of surgery, history of nasoalveolar molding, and technique. Greater CLA correlated with less favorable pairwise ratings (p=0.018).

[CONCLUSIONS] Among patients undergoing bilateral CL repair with PR, higher BCLSI was associated with greater columellar-labial angle and worse nasal appearance scores postoperatively. Overall, the BCLSI may be a clinically useful tool with prognostic relevance for patients undergoing bilateral cleft repair both with and without primary rhinoplasty.