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Clinical Practice Patterns And Evidence-based Medicine In Secondary Cleft Rhinoplasty: A Sixteen-year Review Of Maintenance Of Certification Tracer Data From The American Board Of Plastic Surgery
Alex M. Rokni, BS1, Aaron M. Kearney, MD2, Arun K. Gosain, MD1.
1Lurie Children's Hospital of Chicago, Chicago, IL, USA, 2Northestern University Feinberg School of Medicine, Chicago, IL, USA.

Purpose: As a component of the Maintenance of Certification (MOC) process from 2003 to 2019, the American Board of Plastic Surgery (ABPS) tracked 20 common plastic surgery operations. This study evaluates the data collected for secondary cleft rhinoplasty to examine the practice patterns of pediatric/craniofacial surgeons in the United States.
Methods: Cumulative tracer data for secondary cleft rhinoplasty was reviewed from its inception in 2003 through April, 2014 and September, 2019, and comparison between cumulative data through 2014 and 2019 was made to evaluate for changing trends in practice patterns. Results were tabulated into 3 categories: 1) Pearls, or topics that were covered in both the tracer data and Evidence Based Medicine (EBM) articles; 2) topics that were covered by EBM articles but not collected in the tracer data; 3) topics that were covered in tracer data but not addressed in EBM articles. Statistical analysis was done via chi square test and Fisher's exact test as appropriate.
Results: Cumulative data from 2003 to 2014 consisted of 70 cases, and from 2003 to 2019 consisted of 90 cases. The median age of patients undergoing secondary cleft rhinoplasty was 12 years (range 4-77). Through 2019, 56% were female, 61% had nasal airway obstruction, and 21% had primary nasal correction carried out at the time of cleft lip repair. Common rhinoplasty maneuvers remained consistent from 2014-2019 (Table 1). Through 2019, the most common sources of cartilage were septal (32%) and ear (23%) followed by rib (10%). 72% of patients experienced no complications. The most common complication was asymmetry (10%) followed by "other" (9%) and vertical asymmetry of alar dome position (6%). There were no significant differences in these parameters when cumulative data through 2014 were compared with those through 2019 (p > .05). However, no patients had required reoperation through 2014, whereas 7 (8%) patients had required reoperation through 2019 (p = .019).
Conclusions: ABPS MOC tracer data provides a procedure-specific national database of patients undergoing secondary cleft rhinoplasty. It has the advantage of collecting more specific data with longer follow-up than comparable databases. By analyzing these data over time, we are able to describe trends in practice of pediatric/craniofacial surgery in the United States. Data collected by the tracer but not well studied in the literature provide opportunity for further investigation.
Table 1

Surgical maneuver2014
n = 70
2019
n = 90
p-value
Open approach64 (91%)84 (93%)0.650
Osteotomies14 (20%)22 (24%)0.504
Spreader grafts22 (31%)25 (28%)0.615
Septal Resection/straightening22 (31%)32 (36%)0.584
Columellar strut33 (47%)43 (48%)0.936
Rim grafts17 (24%)21 (23%)0.888
Other graft15 (21%)20 (22%)0.904
Turbinate reduction12 (17%)16 (18%)0.916


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