Portland, Ore.; Madison, Wis.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery and the Department of Orthodontics, Oregon Health and Science University; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health; and the Institute of Reconstructive Plastic Surgery, New York University Medical Center.
Plast Reconstr Surg. 2011 Apr;127(4):1659-1667. doi: 10.1097/PRS.0b013e31820a64d7.
Patients with bilateral cleft lip-cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls.
A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip-cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas.
All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points.
This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip-cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip-cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age.
双侧唇裂腭裂患者存在鼻畸形，包括鼻尖突出度降低、鼻翼基部增宽、鼻中隔缺失或发育不全。作者比较了接受术前鼻牙槽塑形（nasoalveolar molding，NAM）联合唇裂鼻修复术治疗的患者与年龄匹配的非唇腭裂对照者的鼻部形态。
对 77 例非综合征性双侧唇裂腭裂患者进行了纵向回顾性研究。在 12.5 年的时间跨度内，测量了 5 个时间点的鼻尖突出度、鼻翼基部宽度、鼻翼宽度、鼻中隔长度和鼻中隔宽度。采用单样本 t 检验对治疗组与 Farkas 等发表的非唇腭裂年龄匹配对照组进行统计学比较。
在治疗组中，所有 5 项测量指标均呈现出与非唇腭裂组相似的平行、比例性生长。在 12.5 岁时，治疗组的鼻尖突出度、鼻翼基部宽度、鼻翼宽度、鼻中隔长度和鼻中隔宽度与非唇腭裂年龄匹配对照组无统计学差异。在 7 岁和 12.5 岁时，鼻尖突出度的长度也无差异。前 4 个时间点的鼻翼宽度和鼻翼基部宽度明显更宽。
这是第一项描述双侧唇裂腭裂患者接受 NAM 和唇裂一期修复术后至 12.5 岁时鼻部形态的研究。本研究表明，作者所在机构采用 NAM 联合唇裂鼻修复术治疗双侧唇裂腭裂患者，在唇裂修复时同期进行鼻整形手术，患者在 12.5 岁时可获得接近正常的鼻部形态。
