Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland.
Orthod Craniofac Res. 2013 Feb;16(1):36-43. doi: 10.1111/ocr.12002. Epub 2012 Sep 17.
To evaluate facial esthetics in patients with unilateral cleft lip and palate (UCLP) after alveolar bone grafting combined with rhinoplasty between 2 and 4 years of age.
Retrospective case-control study.
The Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland.
Photographs of full faces and cropped images of five nasolabial components: nasal deviation, nasal form, nasal profile, vermillion border, and inferior view were assessed by 5 professional and 14 layraters in 29 children (23 boys and 6 girls; mean age = 5.3 years, SD 0.5; Early-grafted group) and 30 children (20 boys and 10 girls; mean age = 5.5 years, SD 1.0; Non-grafted group) with complete unilateral cleft lip and palate repaired with a one-stage closure. The groups differed regarding the timing of alveolar bone grafting: in the Early-grafted group, alveolar bone grafting in combination with rhinoplasty (ABG-R) was performed between 2 and 4 years of age (mean age = 2.3 years; SD 0.6); in the Non-grafted group, the alveolar defect was grafted after 9 years of age. No primary nose correction was carried out in any group. To rate esthetics, a modified five-grade esthetic index of Asher-McDade was used, where grade 1 means the most esthetic and grade 5 - the least esthetic outcome.
Esthetics of full faces and of all nasolabial elements in the Early-grafted group was significantly better than in Non-grafted group. The scores in the Early-grafted group ranged from 2.30 to 2.66 points, whereas in the Non-grafted group ranged from 2.66 to 3.17 points. All intergroup differences were statistically significant (p < 0.05).
Three years post-operatively, early alveolar bone grafting combined with rhinoplasty is favorable for facial esthetics in children with UCLP, but a longer follow-up is needed to assess whether the improvement was permanent.
评估 2 至 4 岁行牙槽骨植骨联合鼻整形术的单侧唇腭裂（UCLP）患者的面部美观度。
回顾性病例对照研究。
波兰华沙母婴研究所小儿外科。
由 5 名专业评估者和 14 名非专业评估者对 29 名儿童（23 名男孩和 6 名女孩；平均年龄=5.3 岁，标准差 0.5；早期植骨组）和 30 名儿童（20 名男孩和 10 名女孩；平均年龄=5.5 岁，标准差 1.0；未植骨组）的全脸照片和五个鼻唇组件的裁剪图像（鼻侧偏斜、鼻型、鼻侧轮廓、红唇缘和下视图）进行评估。两组的差异在于牙槽骨植骨的时间：在早期植骨组中，牙槽骨植骨联合鼻整形术（ABG-R）于 2 至 4 岁时进行（平均年龄=2.3 岁；标准差 0.6）；在未植骨组中，牙槽骨缺损在 9 岁后进行植骨。两组均未行初次鼻矫正。为了评估美观度，采用了改良的 Asher-McDade 五级美学指数，其中 1 级表示最美观，5 级表示最不美观。
早期植骨组的全脸和所有鼻唇组件的美观度明显优于未植骨组。早期植骨组的评分范围为 2.30 至 2.66 分，而未植骨组的评分范围为 2.66 至 3.17 分。所有组间差异均具有统计学意义（p<0.05）。
术后 3 年，早期牙槽骨植骨联合鼻整形术有利于 UCLP 患儿的面部美观度，但需要更长时间的随访来评估改善是否持久。
