Rossell-Perry Percy
Post Graduate Studies School of Medicine, San Martin de Porres University, Santa Anita, Peru; and Department of Plastic Surgery, Edgardo Rebagliati Hospital, Lima, Peru.
Plast Reconstr Surg Glob Open. 2020 Aug 20;8(8):e3044. doi: 10.1097/GOX.0000000000003044. eCollection 2020 Aug.
The purposes of this study were to evaluate surgical outcomes after primary surgery to address unilateral cleft lip, nose, and palate deformities and to perform a review of the literature to evaluate the effects of nasoalveolar molding (NAM) plus primary surgical repair on nonsyndromic unilateral cleft lip and palate.
A cohort study of 37 primary complete unilateral cleft lip nasal deformity repairs was performed by a single surgeon. The outcomes were anthropometric measurements of the repaired lip, nose, and alveolar cleft width at the age of 1 and 5 years. A review of the literature was performed for studies published until March 2020 to evaluate the effect of presurgical NAM on nasolabial aesthetics.
Statistically significant differences were observed between pre- and postoperative columellar angle and alveolar cleft width. A total of 308 studies were identified, and 8 were included in the final analysis of 684 patients. The overall study quality was low according to the Oxford Centre of Evidence-Based Medicine, and GRADE level of evidence was low.
Primary cheilorhinoplasty alone is a good approach to improve nose appearance and alveolar gap in patients with unilateral cleft lip nose and palate deformity. Definitive conclusions about the effectiveness of presurgical NAM cannot be drawn. Available scientific evidence is not sufficient to demonstrate that combined use of presurgical nasoalveolar molding and primary surgery provides better nasolabial aesthetic outcomes than does primary surgery alone.
本研究的目的是评估初次手术治疗单侧唇裂、鼻裂和腭裂畸形后的手术效果,并对文献进行综述,以评估鼻牙槽塑形(NAM)加初次手术修复对非综合征性单侧唇腭裂的影响。
由一名外科医生对37例原发性完全性单侧唇鼻畸形修复进行队列研究。结果指标为1岁和5岁时修复后的唇部、鼻部和牙槽裂宽度的人体测量数据。对截至2020年3月发表的研究进行文献综述,以评估术前NAM对鼻唇美学的影响。
术前和术后的鼻小柱角和牙槽裂宽度存在统计学上的显著差异。共识别出308项研究,其中8项纳入了对684例患者的最终分析。根据牛津循证医学中心的标准,总体研究质量较低,证据的GRADE级别也较低。
单纯初次唇鼻整形术是改善单侧唇鼻腭裂畸形患者鼻部外观和牙槽间隙的良好方法。关于术前NAM有效性的明确结论尚无法得出。现有科学证据不足以证明术前鼻牙槽塑形与初次手术联合使用比单纯初次手术能提供更好的鼻唇美学效果。