From the Division of Plastic Surgery, Summa Health System, Akron.
Northeast Ohio Medical University, Rootstown.
Ann Plast Surg. 2022 May 1;88(5):513-517. doi: 10.1097/SAP.0000000000003112. Epub 2022 Mar 10.
Evaluating outcomes after cleft rhinoplasty can be challenging because of the lack of objective measures that would lead to a more desirable outcome.
This study is a 10-year retrospective review of 30 consecutive patients who underwent secondary unilateral cleft rhinoplasty performed by a single surgeon. Subjective ratings were made using the Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE), which rates 4 components (nose, cupid's bow, lateral lip, and free vermillion) with a score of 0 to 2. Multiple anthropometric measurements (nostril height ratio, width ratio, medial ¼ height ratio, sill ratio, nostril area ratio, columellar angle, tip projection ratio, and nasolabial angle) were taken using a free National Institutes of Health program, ImageJ. Standardized photographs were compared at T0 (preoperatively), T1 (<6 weeks postoperatively), and T2 (>6 weeks postoperatively).
There were 30 patients who met our inclusion criteria: 10 males (66.7%) and 20 females (66.7%). Of these patients, 26 (86.7%) had a complete cleft lip and 4 (13.3%) had an incomplete cleft lip. The patients' average age at time of surgery was 16.2 years with a mean follow-up of 17.9 months. Subjective scores in both nasal and overall UCL SOE ratings improved from T0 to T1, 0.7 to 1.2 (P ≤ 0.001) and 3.6 to 4.7 (P ≤ 0.001), respectively. Visual analog scores in nasal and overall UCL SOE ratings improved between T0 and T2, 0.7 to 0.9 (P = 0.023) and 3.6 to 4.8 (P = 0.002), respectively. Of all the objective measures, nasal sill ratio and cleft height to width ratio correlated with improved subjective ratings across multiple time points.
Our study shows that objective measures such as nasal sill and nostril shape (cleft height to width ratio) correlate with improved subjective visual analog scale using the UCL SOE. The nasal sill is an often overlooked, yet essential, part of creating an aesthetically pleasing nose during cleft rhinoplasty.
由于缺乏能够带来更理想结果的客观测量标准，评估唇裂鼻整形术后的效果具有一定挑战性。
本研究是对 30 例连续患者进行的 10 年回顾性研究，这些患者均由同一位外科医生行单侧唇裂鼻二次整复术。使用单侧唇裂手术效果评价量表（UCL SOE）进行主观评分，该量表对 4 个部分（鼻子、丘比特弓、侧唇和游离红唇）进行评分，评分为 0 到 2 分。使用免费的 NIH 程序 ImageJ 进行多个人体测量（鼻孔高度比、宽度比、内侧 1/4 高度比、鼻翼基底宽度比、鼻孔面积比、鼻中隔角、鼻尖突出率和鼻唇角）。比较 T0（术前）、T1（术后＜6 周）和 T2（术后＞6 周）时的标准照片。
共有 30 例患者符合纳入标准：男 10 例（66.7%），女 20 例（66.7%）。这些患者中，26 例（86.7%）为完全性唇裂，4 例（13.3%）为不完全性唇裂。患者手术时的平均年龄为 16.2 岁，平均随访时间为 17.9 个月。UCL SOE 中鼻部和整体评分均从 T0 到 T1 有所改善，分别从 0.7 分提高至 1.2 分（P ≤ 0.001）和从 3.6 分提高至 4.7 分（P ≤ 0.001）。UCL SOE 中鼻部和整体的视觉模拟评分也从 T0 到 T2 有所改善，分别从 0.7 分提高至 0.9 分（P = 0.023）和从 3.6 分提高至 4.8 分（P = 0.002）。在所有客观指标中，鼻部鼻翼基底宽度比和鼻翼裂宽度与多个时间点的主观评分改善相关。
本研究表明，客观指标如鼻底和鼻孔形状（鼻翼裂宽度与高度比）与使用 UCL SOE 的主观视觉模拟评分改善相关。在唇裂鼻整形术中，鼻底是创造美观鼻部的一个经常被忽视但又至关重要的部分。
