Lu Ting-Chen, Yao Chuan-Fong, Lin Susie, Chang Chun-Shin, Chen Philip Kuo-Ting
Taoyuan, Taiwan.
From the Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; and College of Medicine, Chang Gung University.
Plast Reconstr Surg. 2017 May;139(5):1177-1186. doi: 10.1097/PRS.0000000000003297.
Since 2006, the authors have explored the option of using septal cartilage as an alar rim graft on the cleft side during primary rhinoplasty to improve nasal symmetry. The aim of this study was to compare the nasal shape with or without rim graft.
A total of 98 patients with unilateral complete cleft lip and palate were included; 39 patients had septal cartilage as the rim graft, and 59 patients did not. Measurements of the nostril height, nostril width, one-fourth medial part of nostril height, nostril area, nasal dome height, and nostril axis were obtained on the cleft and noncleft sides. Ratios of these measurements were calculated. These ratios were then compared between the graft and nongraft groups. The levels of asymmetry were categorized into four levels-less than 5 percent, 5 to 10 percent, 10 to 15 percent, and greater than 15 percent-based on the percentages deviated from perfect symmetry (100 percent). Panel assessment was also performed. Nasolabial angle and tip projection ratio were measured for the comparison of nasal growth.
The nostril height, height-to-width ratio, and nasal dome height were higher in the graft group (p = 0.003, p < 0.001, and p < 0.001, respectively). The graft group showed more consistency regarding the nostril shape and axis, and the differences were statistically significant (p < 0.05). The nasolabial angle and tip projection ratio showed no significant difference between the two groups.
This preliminary study suggests that the use of a primary septal cartilage graft may offer better support at the alar rim and improve the long-term outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
自2006年以来，作者探讨了在初次鼻整形术中使用鼻中隔软骨作为唇裂侧鼻翼缘移植材料以改善鼻对称性的可能性。本研究的目的是比较使用或不使用鼻翼缘移植材料时的鼻外形。
共纳入98例单侧完全性唇腭裂患者；39例患者使用鼻中隔软骨作为鼻翼缘移植材料，59例患者未使用。测量唇裂侧和非唇裂侧的鼻孔高度、鼻孔宽度、鼻孔高度的内侧四分之一部分、鼻孔面积、鼻穹窿高度和鼻孔轴。计算这些测量值的比值。然后比较移植组和非移植组之间的这些比值。根据与完美对称（100%）的偏差百分比，将不对称程度分为四个等级——小于5%、5%至10%、10%至15%和大于15%。还进行了小组评估。测量鼻唇角和鼻尖突出率以比较鼻生长情况。
移植组的鼻孔高度、高宽比和鼻穹窿高度更高（分别为p = 0.003、p < 0.001和p < 0.001）。移植组在鼻孔形状和轴方面表现出更高的一致性，差异具有统计学意义（p < 0.05）。两组之间的鼻唇角和鼻尖突出率无显著差异。
这项初步研究表明，初次鼻中隔软骨移植可能在鼻翼缘提供更好的支撑并改善长期效果。
临床问题/证据水平：治疗性，III级。
