From the Departments of Surgery and Otolaryngology, United Christian Hospital; the Craniofacial Research Center, Department of Plastic Surgery, Chang Gung Memorial Hospital; the Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University; the Craniofacial Center, Department of Plastic Surgery, Taipei Medical University Hospital; and the Division of Plastic and Reconstructive Surgery, Philippine General Hospital.
Plast Reconstr Surg. 2020 Mar;145(3):775-779. doi: 10.1097/PRS.0000000000006586.
Since 2012, the senior author has incorporated the natural curvature of rib cartilage as an alar rim graft in addition to the diced cartilage technique for unilateral cleft rhinoplasty. The aim of this study is to describe this modification and evaluate its long-term results regarding nasal symmetry using three-dimensional stereophotogrammetric assessment (3dMDface system).
From 2012 to 2018, 47 consecutive patients that underwent secondary unilateral cleft rhinoplasty were reviewed retrospectively. Sixteen patients with both preoperative and postoperative three-dimensional photographs taken at least 6 months after the operation were included. SimPlant O&O software was used to measure parameters on three-dimensional photographs: nostril heights, nostril widths, nasal dorsum heights, alare width, nostril areas, overlapping nostril area, nasal tip protrusion, nasal length, and nasal height before and after surgery. The ratios between cleft and noncleft sides were calculated. In addition, the overlapping nostril area ratio, tip protrusion-width index, and nasal index were compared before and after surgery.
The preoperative nostril height ratio (0.79), nostril width ratio (1.24), and nasal dome height ratio (0.84) between cleft and noncleft sides were significantly improved after surgery to 0.93, 1.06, and 0.97, respectively. The preoperative overlapping nostril area ratio (72.33 percent), nasal tip protrusion-width index (0.48), and nasal index (0.81) also showed significant improvement postoperatively to 83.91 percent, 0.57, and 0.74, respectively.
This preliminary study supports the use of natural curvature of rib cartilage as alar rim graft in secondary unilateral cleft rhinoplasty, with long-term improvement regarding nasal symmetry and nasal profile.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自 2012 年以来，资深作者在单侧唇裂鼻整形术中除了使用软骨丁技术外，还将肋软骨的自然曲度作为鼻翼缘移植物。本研究旨在描述这一改良方法，并使用三维立体摄影评估（3dMDface 系统）评估其长期的鼻对称性结果。
从 2012 年到 2018 年，回顾性分析了 47 例连续接受二次单侧唇裂鼻整形术的患者。纳入了 16 例术前和术后至少 6 个月均有三维照片的患者。使用 SimPlant O&O 软件测量三维照片上的参数：鼻孔高度、鼻孔宽度、鼻背高度、鼻翼宽度、鼻孔面积、重叠鼻孔面积、鼻尖突出度、鼻长和术前术后的鼻高。计算裂侧和非裂侧的比值。此外，比较了术前和术后的重叠鼻孔面积比、鼻尖突出宽度指数和鼻指数。
裂侧和非裂侧术前的鼻孔高度比（0.79）、鼻孔宽度比（1.24）和鼻穹窿高度比（0.84）在术后分别显著改善至 0.93、1.06 和 0.97。术前重叠鼻孔面积比（72.33%）、鼻尖突出宽度指数（0.48）和鼻指数（0.81）在术后也分别显著改善至 83.91%、0.57 和 0.74。
这项初步研究支持在二次单侧唇裂鼻整形术中使用肋软骨的自然曲度作为鼻翼缘移植物，可长期改善鼻对称性和鼻轮廓。
临床问题/证据水平：治疗，IV。
