Sertel Serkan, Venara-Vulpe Ioana-Irina, Gorostidi François, de Buys Roessingh Anthony, Pasche Philippe
From the *Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital CHUV, Lausanne, Switzerland; †Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany; and ‡Department of Paediatric Surgery, University Hospital CHUV, Lausanne, Switzerland.
Ann Plast Surg. 2017 Dec;79(6):571-576. doi: 10.1097/SAP.0000000000001171.
The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities.
We present a retrospective case study of 21 patients with moderate unilateral cleft lip nose deformities who underwent secondary septorhinoplasty with an L-shaped septal extension spreader graft combined with alar rim, alar batten graft, and soft tissue repositioning. Exclusion criteria were severe or complex septal deviation avoiding a stable fixation of the graft. Mean follow-up time was 28 months. Surgical outcomes were analyzed by anthropometric measurements of standardized preoperative and postoperative photographs.
All parameters improved except for the nostril height. The height between the alar base and the dome defining dome symmetry, as well as the angles between the lower lateral cartilage and the alar base (α) defining the orientation of the alar rim, improved significantly. The mean ratios of cleft/noncleft side of the height between the alar base and the dome and α showed statistically significant improvements from 0.833 (preoperative) to 0.994 (postoperative) (P < 0.0001) and from 0.883 to 1.02 (P = 0.0038), respectively.
The L-shaped septal extension spreader graft combined with alar batten graft and soft tissue repositioning is an option for secondary rhinoplasties in unilateral cleft lip nose deformities minimizing tip rigidity with significant improvement of the dome's height and its symmetry, as well as the alar side angle.
单侧唇裂鼻具有众多复杂且相互依存的畸形特征。二期鼻整形技术旨在通过多种操作来纠正唇裂鼻畸形，这些操作包括鼻中隔和鼻棘的内侧化、鼻翼软骨以及软组织的松动和重新定位。此外，软骨移植常用于恢复鼻尖的适当突出度和鼻对称性。我们介绍一种常用于非唇裂鼻整形的软骨移植技术，该技术已针对中度唇裂鼻畸形病例进行了改良。
我们对21例中度单侧唇裂鼻畸形患者进行了一项回顾性病例研究，这些患者接受了二期鼻中隔鼻整形术，采用L形鼻中隔延伸撑开移植联合鼻翼缘、鼻翼支撑移植和软组织重新定位。排除标准为严重或复杂的鼻中隔偏曲，以免影响移植的稳定固定。平均随访时间为28个月。通过对标准化术前和术后照片进行人体测量分析手术效果。
除鼻孔高度外，所有参数均有改善。定义鼻尖对称性的鼻翼基部与鼻尖之间的高度，以及定义鼻翼缘方向的下外侧软骨与鼻翼基部之间的角度（α）均有显著改善。鼻翼基部与鼻尖之间高度以及α的裂隙侧/非裂隙侧平均比值分别从0.833（术前）显著改善至0.994（术后）（P < 0.0001）和从0.883改善至1.02（P = 0.0038）。
L形鼻中隔延伸撑开移植联合鼻翼支撑移植和软组织重新定位是单侧唇裂鼻畸形二期鼻整形的一种选择，可将鼻尖硬度降至最低，显著改善鼻尖高度及其对称性以及鼻翼侧角。
