Gassling Volker, Koos Bernd, Birkenfeld Falk, Wiltfang Jörg, Zimmermann Corinna E
Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Orthodontics, University Hospital of Rostock, Rostock, Germany.
J Craniomaxillofac Surg. 2015 Nov;43(9):1855-62. doi: 10.1016/j.jcms.2015.08.012. Epub 2015 Aug 29.
Secondary rhinoplasty in cleft lip and palate (CLP) is commonly the last step in a set of surgical procedures that result in a variable but typically intensive change in facial appearance. However, there is evidence that the sentiment about the aesthetic and functional outcomes between patients and surgeons is different. The present study aimed to evaluate the subjective and objective outcomes of secondary rhinoplasty in patients with CLP.
Secondary rhinoplasty was performed in 10 patients with repaired unilateral CLP via a standardized open approach. For the subjective evaluation, the patients completed the rhinoplasty outcome evaluation (ROE) questionnaire. Pre- and postoperative photographic documentation served as the basis for the objective evaluation, which included the following: (1) assessment by five specialists at craniofacial malformation consultation appointments and by three doctors in continuing education using the Asher-McDade aesthetic index (AMAI) rating, and (2) metric facial analysis to determine the nasofrontal angle and the nasolabial angle.
Patient satisfaction was high, based on the evaluation of the ROE questionnaire. The analysis of the AMAI rating questionnaire showed no significant differences between the positive ratings of the 'experienced' and 'inexperienced' doctors. In contrast, there was an obvious and significant difference between the 'preoperative' and 'postoperative' time points for questions 1-3. The metric analysis showed statistically significant improvements of the nasolabial angle and the nasofrontal angle. The subjective and objective outcome evaluations were descriptively congruent.
The data suggest that standardized secondary rhinoplasty in CLP leads to both a subjective and a statistically significant objective improvement of facial appearance and thus may support the psychosocial rehabilitation of affected patients. Furthermore, our results showed that the subjective and objective outcome evaluations of secondary rhinoplasty were largely compatible.
唇腭裂（CLP）二期鼻整形术通常是一系列外科手术的最后一步，这些手术会对面部外观产生不同程度但通常较为显著的改变。然而，有证据表明患者和外科医生对美学和功能结果的看法存在差异。本研究旨在评估唇腭裂患者二期鼻整形术的主观和客观结果。
对10例单侧唇腭裂修复患者采用标准化开放式入路进行二期鼻整形术。为进行主观评估，患者完成鼻整形术结果评估（ROE）问卷。术前和术后的照片记录作为客观评估的基础，客观评估包括以下内容：（1）由五位颅面畸形会诊专家和三位参加继续教育的医生使用阿舍 - 麦克戴德美学指数（AMAI）评分进行评估，以及（2）进行面部测量分析以确定鼻额角和鼻唇角。
根据ROE问卷评估，患者满意度较高。对AMAI评分问卷的分析表明，“经验丰富”和“经验不足”的医生给出的正面评分之间没有显著差异。相比之下，问题1 - 3在“术前”和“术后”时间点之间存在明显且显著的差异。测量分析显示鼻唇角和鼻额角有统计学上的显著改善。主观和客观结果评估在描述上是一致的。
数据表明，唇腭裂标准化二期鼻整形术可使面部外观在主观和统计学上都得到显著改善，从而可能有助于受影响患者的心理社会康复。此外，我们的结果表明，二期鼻整形术的主观和客观结果评估在很大程度上是相符的。
