Davidson Edward, Kumar Anand R
*Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA †Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Craniofac Surg. 2015 Oct;26(7):e629-33. doi: 10.1097/SCS.0000000000002102.
Nasal aesthetic changes after cleft orthognathic surgery remain understudied. Previous scarring associated with prior cleft surgery may affect the predictability of outcomes after jaw surgery. This study evaluates changes in nasal aesthetics using three-dimensional photography after Le Fort I advancement in patients with nonsyndromic cleft-related maxillary hypoplasia. Cephalometric parameters were recorded pre- and postoperatively. Three-dimensional photogrammetric imaging analyzed changes in interalar width (IAW), internostril width (INW), nasal tip projection (NTP), collumelar length (CL), nasal labial angle (NLA), and nasal length (NL). Statistical significance between pre- and postoperative data was determined using T-tests for each parameter. Eleven patients underwent either single piece Le Fort I osteotomy and advancement, (3 bilateral, 4 unilateral cleft lip, and palate), or 2-piece advancement (2 bilateral, 2 unilateral). Average nasal soft tissue changes were IAW 1.9 mm (0.4-4.2), INW -0.2 mm (-2.8 to 1.6), NTP -1.0 mm (-4.0 to 2.0), CL -0.7 mm (-2.9 to 1.5), NLA -0.2° (-13.9 to 15.1), and NL -0.7 mm (-4.3 to 1.5), (P = 0.001, 0.6, 0.08, 0.01, 0.9, 0.2). For single-piece osteotomy alone changes were IAW 2.1 mm (0.6-4.1), INW -0.6 mm (-2.8 to 1.7), NTP -1.9 mm (-4.0 to 0.3), CL -1.2 mm (-2.9 to 0.03), NLA -1.3° (-13.9 to 15.0), and NL -1.1 mm (-4.3 to 0.7), (P = 0.007, 0.3, 0.009, 0.0002, 0.7, 0.2). For 2-piece osteotomy alone changes were IAW 1.6 mm (-0.4 to 3.3), INW 0.5 mm (0.4-1.6), NTP 0.5 mm (-1.1-2.0), CL 0.2 mm (-1.4 to 1.5), NLA 2.8° (-7.6 to 10.1), and NL -0.1 mm (-1.4 to 1.5), (P = 0.2, 0.4, 0.5, 0.6, 0.5, 0.9). Cleft-related scarring and malposition affect changes in nasal aesthetics following maxillary advancement that are different to the noncleft population. Two-piece Le Fort I increases variability of changes in nasal aesthetics compared with single-piece advancement.
腭裂正颌手术后的鼻部美学变化仍未得到充分研究。先前腭裂手术相关的瘢痕可能会影响颌骨手术后结果的可预测性。本研究使用三维摄影评估非综合征性腭裂相关上颌骨发育不全患者在Le Fort I前移术后的鼻部美学变化。术前和术后记录头影测量参数。三维摄影测量成像分析了鼻翼间宽度（IAW）、鼻孔内宽度（INW）、鼻尖突出度（NTP）、鼻小柱长度（CL）、鼻唇角（NLA）和鼻长度（NL）的变化。使用T检验确定每个参数术前和术后数据之间的统计学显著性。11例患者接受了单块Le Fort I截骨术和前移术（3例双侧、4例单侧唇腭裂）或两块式前移术（2例双侧、2例单侧）。平均鼻部软组织变化为IAW 1.9毫米（0.4 - 4.2）、INW -0.2毫米（-2.8至1.6）、NTP -1.0毫米（-4.0至2.0）、CL -0.7毫米（-2.9至1.5）、NLA -0.2°（-13.9至15.1）和NL -0.7毫米（-4.3至1.5），（P = 0.001、0.6、0.08、0.01、0.9、0.2）。仅单块截骨术的变化为IAW 2.1毫米（0.6 - 4.1）、INW -0.6毫米（-2.8至1.7）、NTP -1.9毫米（-4.0至0.3）、CL -1.2毫米（-2.9至0.03）、NLA -1.3°（-13.9至15.0）和NL -1.1毫米（-4.3至0.7），（P = 0.007、0.3、0.009、0.0002、0.7、0.2）。仅两块式截骨术的变化为IAW 1.6毫米（-0.4至3.3）、INW 0.5毫米（0.4 - 1.6）、NTP 0.5毫米（-1.1 - 2.0）、CL 0.2毫米（-1.4至1.5）、NLA 2.8°（-7.6至10.1）和NL -0.1毫米（-1.4至1.5），（P = 0.2、0.4、0.5、0.6、0.5、0.9）。腭裂相关的瘢痕和错位会影响上颌前移术后的鼻部美学变化，这与非腭裂人群不同。与单块式前移术相比，两块式Le Fort I增加了鼻部美学变化的可变性。
