Spolyar John L, Roldán J Camilo
UDM School of Dent, Dept. of Orthodontics, Detroit, MI, USA; Ian Jackson Craniofacial & Cleft Palate Clinic, Wm Beaumont Hospital, Royal Oak, MI, USA; Craniofacial Institute of Michigan, St John Providence Health System, Detroit, MI, USA; St John Providence Hospital, Southfield and Novi, MI, USA; Orthodontics at 39611 Garfield Rd. - Suite 12, Clinton Twp, MI 48038, USA.
Division Craniofacial Plastic Surgery, Catholic Children's Hospital Wilhelmstift, Lilinecronstr. 130, Hamburg 22149, Germany; Craniofacial Institute of Michigan, St John Providence Park Hospital, Novi, MI, USA.
J Craniomaxillofac Surg. 2015 Jul;43(6):779-89. doi: 10.1016/j.jcms.2015.03.019. Epub 2015 Apr 15.
Residual deformity of the nose, not lip, continues to be the greater challenge in UCCLP rehabilitation. Platform distortions often re-emerge following primary reconstruction revealing the stereotypical cleft-nose. Nasal alveolar molding reduces nose asymmetry. However, this study applies directional mechanics to the underlying platform distortions and soft tissue nose, introducing a novel device addressing the distorted septo-premaxillary junction.
Retrospective assessment of 47 UCCLP patients by 2-dimensional photographic analysis with 24 subjects treated by dento-maxillary advancement (DMA) and nasal septum button-head pin (NSBP), 17 having nasal molding (NM), compared to 23 subjects without nose treatment, 16 with DMA and 7 with passive plates. Measurements were assessed by t tests, ≤ 05 confidence.
Frontal view: nose-treatment sample achieved ideal ala-bases vertical symmetry (p = 0.00065 & 0.00073); significantly improved ala-rims "slump" angle (p = 0.0071). Both samples had nose positioning within the facial frame like non-cleft population. Sub-nasal view: significant differences were for columella angle (p = 0.0015), nares "offset" (p = 0.002), and columella symmetry (p = 0.022) with nose-treatment achieving near ideal columella symmetry score (0.92) vs. (0.81).
NM and the novel NSBP procedures integrated with the platform correction effect of the DMA successfully treated at three distorted anatomic-levels native to UCCLP to improve nasal aesthetics.
在单侧完全性唇腭裂修复中，鼻部而非唇部的残余畸形仍是更大的挑战。初次重建后，牙槽平台畸形常再次出现，呈现典型的腭裂鼻畸形。鼻牙槽塑形可减少鼻不对称。然而，本研究将定向力学应用于潜在的平台畸形和鼻部软组织，引入了一种新型装置来解决鼻中隔-前上颌骨连接处的畸形问题。
通过二维摄影分析对47例单侧完全性唇腭裂患者进行回顾性评估，其中24例接受牙-上颌骨前移（DMA）和鼻中隔纽扣头钉（NSBP）治疗，17例接受鼻塑形（NM），另外23例未进行鼻部治疗，其中16例接受DMA，7例使用被动板。通过t检验评估测量结果，置信度≤0.05。
正面观：鼻部治疗组实现了理想的鼻翼基底垂直对称（p = 0.00065和0.00073）；鼻翼边缘“塌陷”角度显著改善（p = 0.0071）。两组患者的鼻部在面部框架中的位置均与非腭裂人群相似。鼻下观：两组在鼻小柱角度（p = 0.0015）、鼻孔“偏移”（p = 0.002）和鼻小柱对称性（p = 0.022）方面存在显著差异，鼻部治疗组的鼻小柱对称评分接近理想值（0.92），而另一组为（0.81）。
鼻塑形和新型鼻中隔纽扣头钉手术与牙-上颌骨前移的平台矫正效果相结合，成功治疗了单侧完全性唇腭裂固有的三个解剖层面的畸形，改善了鼻部美观。
