Funayama Emi, Yamamoto Yuhei, Oyama Akihiko, Furukawa Hiroshi, Murao Naoki, Hayashi Toshihiko, Maeda Taku, Osawa Masayuki
Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo.
Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan.
J Craniofac Surg. 2019 Jan;30(1):133-136. doi: 10.1097/SCS.0000000000004959.
The timing of cleft lip nose surgery remains controversial. The less invasive the procedure at the time of primary cleft lip repair, the less the growth and development of the nose is affected. Therefore, the nasal-stenting component of presurgical nasoalveolar molding has increasingly been used. However, not all cleft centers use such treatment. Conventional postsurgical placement of silicone nasal retainers remains popular. No report has yet compared presurgical nasal stenting (preNS) and postsurgical nasal retainer placement (postNR). In this study, postoperative nasal form outcomes after primary lip repair using preNS or postNR in patients with complete unilateral cleft lips, alveoli, and palates were compared. Patients in whom preNS alone was used for 6 months (group I) were compared with those receiving postNR (no preNS) for 6 months after primary nasal cartilage dissection (group II) and controls with no appliance (group III). Nasal anthropometric distances and angular relationships were measured photographically to assess nasal symmetry at 4 years of age in all groups. Compared to group III, groups I and II exhibited significantly greater nostril heights (P = 0.0075, P = 0.0015 respectively) and columellar deviation angles (P = 0.0020, P = 0.0221). Groups I and II did not differ significantly. No significant between-treatment difference in terms of nasal symmetry between preNS and postNR was observed. However, both treatments afforded significantly better results than no treatment. Since older infants tend to resist the placement of nasal devices, preNS is more feasible in this age group.
唇裂鼻手术的时机仍存在争议。在初次唇裂修复时手术侵入性越小，对鼻子生长发育的影响就越小。因此，术前鼻牙槽塑形的鼻支架组件越来越多地被使用。然而，并非所有腭裂治疗中心都采用这种治疗方法。术后常规放置硅胶鼻托仍然很普遍。尚无报告比较术前鼻支架置入（preNS）和术后鼻托放置（postNR）的效果。在本研究中，比较了完全性单侧唇裂、牙槽突裂和腭裂患者初次唇裂修复后采用preNS或postNR的术后鼻外形结果。将仅使用preNS 6个月的患者（I组）与初次鼻软骨分离术后接受postNR（未使用preNS）6个月的患者（II组）以及未使用矫治器的对照组（III组）进行比较。在所有组中，于4岁时通过摄影测量鼻人体测量距离和角度关系，以评估鼻对称性。与III组相比，I组和II组的鼻孔高度显著更高（分别为P = 0.0075，P = 0.0015），鼻中隔偏斜角度也更大（分别为P = 0.0020，P = 0.0221）。I组和II组之间无显著差异。未观察到preNS和postNR在鼻对称性方面的治疗差异显著。然而，两种治疗方法的效果均明显优于不治疗。由于较大婴儿往往抗拒鼻装置的放置，因此preNS在该年龄组更可行。
