Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia.
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Craniofac Surg. 2022 Sep 1;33(6):1762-1768. doi: 10.1097/SCS.0000000000008728. Epub 2022 Jul 26.
The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting.
Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics.
During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039).
Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.
本研究旨在评估不同重建策略矫正唇裂鼻畸形的流行病学和围手术期并发症，尤其关注软骨移植的类型和时间。
利用美国外科医师学会全国手术质量改进计划-儿科医院网络，对 2012 年至 2017 年期间在北美进行的唇裂鼻整形术进行回顾性队列研究。分析术后 30 天内的医疗/手术并发症、再次手术和再次入院情况，并采用适当的统计学方法。
在研究期间，3317 例儿科患者接受了唇裂鼻整形术，其中 8.0%涉及软骨移植。耳软骨在中期修复中更常用，而肋软骨在晚期修复中更常用（P=0.006）。总体而言，耳软骨移植的鼻整形术手术时间短于无软骨移植的鼻整形术（P=0.005），而肋软骨移植的鼻整形术手术时间延长（P<0.001）。无论是中期还是晚期唇裂鼻整形术，软骨移植的使用均与并发症增加无关。双侧唇裂患者总体上更有可能接受软骨移植的鼻整形术（P=0.047）和晚期重建的软骨移植（P=0.039）。
耳软骨最常用于中期修复，而肋软骨最常用于唇裂鼻整形术的晚期修复。耳软骨移植与手术时间显著缩短有关，而肋软骨移植与手术时间显著延长有关。毫不奇怪，唇裂鼻整形术相对安全，短期总体并发症发生率为 2%。
