Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu 610041, China.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1436-43. doi: 10.1016/j.bjps.2011.06.022. Epub 2011 Jul 23.
Alveolar bone graft is considered conducive to tooth eruption and maxilla stability in unilateral cleft patients, but its contribution to nasal symmetry is still under discussion. To explore the detailed effects of alveolar bone graft on nasal symmetry and its role in rhinoplasty, 90 mixed-dentition complete unilateral cleft lip and palate patients were studied and categorised according to the operation they underwent during the mixed dentition period (bone graft, secondary rhinoplasty or bone graft and rhinoplasty combined). Standardised frontal and submental oblique photographs were taken before and after surgery, and objective measurements for the evaluation of nasal symmetry were devised. Measurement reliability was examined with the intraclass correlation coefficient. Intra- and inter-group comparisons were performed to explore the effect of bone graft on nasal symmetry and its role in rhinoplasty. The intraclass correlation coefficient values were >0.84. Preoperative inter-group analysis yielded satisfactory comparability. Among the bone-graft-only patients, seven of 10 measurements demonstrated significant differences, five indicated enhanced symmetry and two indicated compromised symmetry. For the rhinoplasty-only patients, all measurements revealed significant improvement. Compared with the patients who underwent rhinoplasty only, those who underwent combined bone graft and rhinoplasty were superior in nasal-base elevation only. The photogrammetric strategy appeared reliable for evaluation of nasal symmetry. Most of the effects imposed by alveolar bone graft on nasal symmetry were localised to the alar base and would be camouflaged by rhinoplasty. Considering the limited benefit in symmetry and the potential risk of more complications, overextended dissection during mixed dentition bone graft may be unnecessary.
牙槽骨移植被认为有利于单侧腭裂患者的牙齿萌出和上颌骨稳定性，但它对鼻对称性的贡献仍存在争议。为了探讨牙槽骨移植对鼻对称性的详细影响及其在鼻整形术中的作用，对 90 例混合牙列期完全单侧唇腭裂患者进行了研究，并根据其在混合牙列期接受的手术进行了分类（骨移植、二期鼻整形术或骨移植和鼻整形术联合）。手术前后拍摄了标准化的正面和颏下斜位照片，并设计了用于评估鼻对称性的客观测量方法。采用组内相关系数检验测量可靠性。进行了组内和组间比较，以探讨骨移植对鼻对称性的影响及其在鼻整形术中的作用。组内相关系数值>0.84。术前组间分析具有良好的可比性。在单纯骨移植组中，10 项测量中有 7 项存在显著差异，其中 5 项提示对称性增强，2 项提示对称性减弱。对于单纯行鼻整形术的患者，所有测量均显示出显著改善。与仅行鼻整形术的患者相比，同时行骨移植和鼻整形术的患者仅在鼻基底抬高方面具有优势。照片测量策略对于评估鼻对称性似乎是可靠的。牙槽骨移植对鼻对称性的影响大多局限于鼻翼基部，可被鼻整形术掩盖。考虑到对称性的获益有限且并发症风险增加，混合牙列期过度广泛的骨移植可能没有必要。
