Fisher D M, Lo L J, Chen Y R, Noordhoff M S
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Plast Reconstr Surg. 1999 Jun;103(7):1826-34. doi: 10.1097/00006534-199906000-00003.
The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; range, 0.5 to 4 mm). In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased S-N-ANS angle with increased alveolar cleft width.
本研究的目的是在一组3个月大、未经手术干预的单侧完全性唇腭裂婴儿中，使用三维计算机断层扫描分析原发性唇裂鼻畸形的几何形态。在将三维图像调整至中立位置（法兰克福水平面、真正的前后位和垂直中线）后，重新配置坐标和轴线。通过调整计算机断层扫描阈值来显示和测量皮肤表面及骨组织。从真正的侧位视图测量S-N、N-ANS、S-N-O和S-N-ANS。从前后位视图测量双眶（LO-LO）、眶间（MO-MO）、内眦间（en-en）和鼻（al-al）宽度。从下视图测量骨性牙槽裂宽度。根据骨性牙槽裂宽度将研究组分为两组：6例腭裂宽度小于10 mm的患者和6例腭裂宽度大于10 mm的患者。两组之间仅S-N-ANS角度存在差异，即腭裂较宽组的该角度更大（p<0.05）。获取鼻底部六个标志点的坐标[蝶鞍点（se）、鼻下点（sn）、裂侧和非裂侧鼻翼基底点（sbal-cl和sbal-ncl），以及梨状孔外侧缘最靠后的点（PPA-CL和PPA-NCL）]，用于分析鼻畸形。平均而言，鼻下点位于蝶鞍点前方并偏向非裂侧；裂侧鼻翼基底点比非裂侧鼻翼基底点更靠内侧、后方和下方；裂侧梨状孔边缘的PPA点比非裂侧的PPA点更靠外侧、后方和下方。并非在所有患者中都普遍观察到这些差异。然而，在所有患者中，无一例外均观察到四个结果（p<0.01）：（1）鼻下点（sn）偏向非裂侧（距中线的平均距离为5.0 mm；范围为2至9.5 mm），（2）裂侧鼻翼基底（sbal-cl）比非裂侧鼻翼基底（sbal-ncl）更靠后（平均差异为3.6 mm；范围为1至5.5 mm），（3）非裂侧鼻翼基底（sbal-ncl）比裂侧鼻翼基底（sbal-cl）离中线更远（sbal-ncl和sbal-cl距中线的横向距离平均差异为2.8 mm；范围为0.半至7 mm），以及（4）裂侧梨状孔边缘（PPA-CL）比非裂侧梨状孔边缘（PPA-NCL）更靠后（平均差异为2.1 mm；范围为0.5至4 mm）。总之，未经手术的单侧唇腭裂鼻畸形具有这四个特征，且随着牙槽裂宽度增加，S-N-ANS角度增大。
