From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine; and the Division of Plastic and Reconstructive Surgery, Northwell Health.
Plast Reconstr Surg. 2019 Mar;143(3):572e-580e. doi: 10.1097/PRS.0000000000005367.
The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psychosocial development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component.
Photomorphometric analyses of unilateral cleft lip and palate patients (n = 50) who underwent intermediate cleft tip rhinoplasty using the component restoration technique were evaluated preoperatively (time 0) and postoperatively at less than 1 year (time 1), 1 to 3 years (time 2), and more than 3 years (time 3) and compared to age-matched unilateral cleft lip and palate control patients. Nasal relationships (alar symmetry, nasal tip protrusion-to-alar base width ratio, and height-to-width dimensions for the cleft and noncleft nostrils) were compared over time using a linear mixed-effect model.
At time 0, both groups demonstrated similar nasal relationships, with the exception of a wider cleft-side nostril in relationship to height in the rhinoplasty group. The component restoration technique improved all four nasal relationships at all postoperative time points compared with time 0 in a statistically significant manner, whereas control patients did not demonstrate significant changes at the corresponding ages. Long-term differences at time 3 revealed a trend toward improved alar symmetry and cleft-side and non-cleft-side nostril dimensions, and a significant improvement in the nasal tip protrusion-to-alar base width ratio in intermediate cleft tip rhinoplasty-treated versus control patients (p = 0.002).
The component restoration technique for the unilateral intermediate cleft tip rhinoplasty improves nasal relationships toward normal immediately and in a sustained manner for at least 3 years.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在儿童期进行中间裂鼻尖成形术，以解决心理社会发育最关键时期残留的鼻尖不对称问题。作者根据每个异常解剖结构单独修复的理念，描述并评估了该方法在单侧唇腭裂患者中的长期效果。
对采用成分修复技术进行中间裂鼻尖成形术的单侧唇腭裂患者（n=50）进行摄影测量分析，在术前（时间 0）和术后 1 年以内（时间 1）、1 至 3 年（时间 2）和 3 年以上（时间 3）进行评估，并与年龄匹配的单侧唇裂患者进行比较。使用线性混合效应模型比较随时间变化的鼻关系（鼻翼对称性、鼻尖突出-鼻翼基底宽度比以及裂侧和非裂侧鼻孔的高度-宽度比）。
在时间 0 时，两组的鼻关系相似，除了在接受成形术的患者中，裂侧鼻孔的高度与宽度之比较宽。与时间 0 相比，成分修复技术在所有术后时间点均显著改善了所有四个鼻关系，而对照组在相应年龄时并未显示出显著变化。在时间 3 时的长期差异显示出鼻翼对称性以及裂侧和非裂侧鼻孔的改善趋势，并且鼻尖突出-鼻翼基底宽度比明显改善，接受中间裂鼻尖成形术治疗的患者与对照组相比（p=0.002）。
单侧中间裂鼻尖成形术的成分修复技术可立即改善鼻关系，并持续至少 3 年。
临床问题/证据水平：治疗，III 级。
