Ganske Ingrid M, Tan Robin A, Langa Olivia C, Calabrese Carly E, Padwa Bonnie L
Assistant Professor, Department of Surgery, Harvard Medical School, and Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
PhD Candidate, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands.
J Oral Maxillofac Surg. 2020 Jun;78(6):998-1005. doi: 10.1016/j.joms.2020.01.010. Epub 2020 Jan 21.
Patients with unilateral cleft lip and palate (UCLP) may require Le Fort I advancement to correct maxillary hypoplasia after reaching skeletal maturity. The underlying cleft anatomy, previous operations, and scarring can affect nostril changes after maxillary advancement. The purpose of the present study was to determine whether Le Fort I advancement affects the nostril configuration (ie, width, axis, shape) in patients with UCLP. The specific aims were to (1) compare cleft and noncleft nostrils in patients with UCLP after maxillary advancement and (2) compare the changes in nostril configuration in patients with UCLP with those in noncleft controls after Le Fort advancement.
A retrospective case-control study of nonsyndromic, skeletally mature patients with UCLP and a case-matched control group without UCLP who had undergone single-piece Le Fort I advancement with alar cinch suture from 2010 to 2014. Patients were included if they had undergone pre- and postoperative 3-dimensional photogrammetry without intervening nasal revision. Three-dimensional anthropometry was used to evaluate changes in nostril axis and width, soft triangle angle, columellar show, and nasal width after orthognathic correction.
The present study included 19 patients with UCLP (11 males; mean age, 18.0 years) and 19 noncleft controls (11 males; mean age, 18.7 years; P = .276). The mean sagittal advancement in the patients with UCLP and noncleft controls was 7.5 mm and 6.3 mm, respectively (P = .143). On average, the nostrils widened, the soft triangles flattened, and the columellar show increased. No significant difference was found in the changes to the nostril configuration between the cleft and noncleft sides in the patients with UCLP. No significant differences were found in the nostril changes between patients with UCLP and noncleft controls.
Baseline nostril asymmetry is not altered by Le Fort osteotomy in patients with UCLP because both nostrils respond similarly to the deforming forces of maxillary advancement. Similarly, no differences were found in the nostril changes between the cleft and noncleft controls. These findings can aid proper surgical planning for cleft nasal revisions.
单侧唇腭裂（UCLP）患者在骨骼成熟后可能需要进行勒福Ⅰ型截骨前移术来矫正上颌骨发育不全。潜在的腭裂解剖结构、既往手术及瘢痕会影响上颌骨前移术后鼻孔的变化。本研究的目的是确定勒福Ⅰ型截骨前移术是否会影响UCLP患者的鼻孔形态（即宽度、轴线、形状）。具体目标为：（1）比较上颌骨前移术后UCLP患者的腭裂侧与非腭裂侧鼻孔；（2）比较勒福Ⅰ型截骨前移术后UCLP患者与非腭裂对照者鼻孔形态的变化。
对2010年至2014年期间接受单块勒福Ⅰ型截骨前移术及鼻翼缩紧缝合术的非综合征性、骨骼成熟的UCLP患者及病例匹配的非UCLP对照组进行一项回顾性病例对照研究。若患者术前及术后均接受了三维摄影测量且未进行鼻腔修复干预，则纳入研究。采用三维人体测量法评估正颌矫正后鼻孔轴线及宽度、软三角角度、鼻小柱显露度及鼻宽度的变化。
本研究纳入19例UCLP患者（11例男性；平均年龄18.0岁）和19例非腭裂对照者（11例男性；平均年龄18.7岁；P = 0.276）。UCLP患者和非腭裂对照者的平均矢状前移量分别为7.5 mm和6.3 mm（P = 0.143）。平均而言，鼻孔变宽，软三角变平，鼻小柱显露度增加。UCLP患者的腭裂侧与非腭裂侧鼻孔形态变化无显著差异。UCLP患者与非腭裂对照者的鼻孔变化也无显著差异。
UCLP患者的基线鼻孔不对称性不会因勒福截骨术而改变，因为两侧鼻孔对上颌骨前移的变形力反应相似。同样，腭裂与非腭裂对照者的鼻孔变化也无差异。这些发现有助于腭裂鼻修复的合理手术规划。
