Henry Ford Hospital, Department of Otolaryngology-Head & Neck Surgery, United States of America.
SUNY Upstate Medical University, Department of Otolaryngology and Communication Sciences, United States of America.
Am J Otolaryngol. 2021 May-Jun;42(3):102908. doi: 10.1016/j.amjoto.2021.102908. Epub 2021 Jan 13.
To determine if there is a benefit of 2-stage cleft lip repair in regard to improving facial symmetry and facilitating definitive lip, nose, and palate repair.
Retrospective chart review of patients born with complete, unilateral cleft lip deformity that underwent a two-stage repair described as a stage 1 straight line repair and a stage 2 modified Millard repair, for which a complete set of records, and peri-operative and post-operative photos were available. All cases were performed by a single surgeon.
Tertiary care center craniofacial team.
Measurements were taken from intraoperative, perioperative, and postoperative images of patients before and after each stage. Ratios were then created comparing the affected size to the unaffected side, and these were averaged between observers.
A 19% increase in the width of area of the presumptive C flap was obtained between the unrepaired and the post-stage I images. The nostril width of the cleft side was 1.2× the width of the unaffected side, demonstrating a 140% decrease in nostril width at the completion of stage II. The cleft side nostril width was maintained slightly larger than the noncleft side as desired. Symmetry of the upper lip length was achieved, as the length of the cleft side lateral lip after stage II was 92% of the unaffected side.
We believe this study provides evidence for our observations that a two-stage repair can be performed with functionally and aesthetically pleasing outcomes as an alternative to presurgical nasoalveolar molding.
确定两阶段唇裂修复在改善面部对称性和促进唇、鼻、腭裂的确定性修复方面是否有益。
对接受过两阶段修复的完全性单侧唇裂畸形患者的病历进行回顾性图表分析，该修复方法描述为一期直线修复和二期改良 Millard 修复。所有病例均由一位外科医生完成。
三级护理中心颅面团队。
在每个阶段前后，从患者的术中、围手术期和术后图像中获取测量值。然后创建了受影响侧与未受影响侧的大小之比，并由观察者进行平均值计算。
在未修复和一期术后图像之间，假定 C 瓣的宽度增加了 19%。裂隙侧鼻孔宽度为未受影响侧的 1.2 倍，表明二期术后鼻孔宽度减少了 140%。裂隙侧鼻孔宽度保持略大于非裂隙侧，符合期望。上唇长度的对称性得到了实现，因为二期术后裂隙侧侧唇的长度为未受影响侧的 92%。
我们认为这项研究为我们的观察结果提供了证据，即两阶段修复可以作为术前鼻牙槽塑形的替代方法，实现功能性和美学效果令人满意的结果。
