Nasal appearance after secondary cleft rhinoplasty: comparison of professional rating with patient satisfaction.

Abstract

The purpose of this study was to compare professional rating and patient satisfaction of nasal appearance after secondary cleft rhinoplasty. We used a cross-sectional study design and enrolled German adults with nonsyndromic unilateral or bilateral cleft lip and/or palate (UCLP and BCLP, respectively) undergoing secondary cleft rhinoplasty from January 2001 to December 2013. The predictor variable was professional rating. The outcome variable was patient satisfaction with postoperative nasal aesthetics. Other study variables included patient age and gender, type of surgery, and patient rating of nasal function. Appropriate descriptive and univariate statistics were computed, and a P value of <0.05 was regarded as statistically significant. Inter-rater reliability was assessed by the use of Cohen's kappa coefficient. The study sample consisted of 242 adult cleft patients of mean age of 22.1±9.2years (range 14-64), including 97 females (40%) and 176 unilateral clefts (73%). Most of the patients reported good function (82%) and good aesthetics (74%). The main professional rating was good aesthetics (65%). Analysis of inter-observer reliability revealed significant differences between patient satisfaction and professional assessment (κ=0.385; P<0.0001). Although most of the patients were satisfied with the functional and aesthetic results of secondary cleft rhinoplasty, patient self-assessment of nasal appearance differed from professional assessment.