From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2023 Feb 1;151(2):385-394. doi: 10.1097/PRS.0000000000009851. Epub 2022 Nov 10.
Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied.
Patients undergoing secondary cleft rhinoplasty at the Children's Hospital of Philadelphia from 2015 to 2021 were identified. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were recorded. Alterations in scores were evaluated for variation depending on patient characteristics, operative maneuvers, and postoperative nasal stenting.
Nasal airway obstruction was present in mild to moderate severity in patients before secondary cleft rhinoplasty. Postoperatively, obstruction improved or resolved in the domains of nasal blockage/obstruction, trouble breathing through the nose, and ability to get enough air through the nose during exertion (P < 0.05). Overall composite Nasal Obstruction Symptom Evaluation scores improved (P < 0.05). Lateral crural strut grafting was associated with improvement in nasal blockage, whereas alar revision and tip sutures were associated with worsening in specific nasal symptoms. Patients who underwent nasal stenting were found to report less trouble breathing after surgery than patients who did not (P < 0.05).
Nasal airway obstruction is present in mild to moderate severity in patients with cleft lip and/or palate, and the subjective severity of obstruction is decreased by secondary cleft rhinoplasty. Specific operative maneuvers are associated with alterations in nasal airway obstructive symptoms, and nasal stenting is associated with an improvement in trouble breathing after secondary cleft rhinoplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
鼻腔气道阻塞在唇裂和/或腭裂患者中是一种日益被认识到的现象，有可能显著影响该患者群体的生活质量。迄今为止，二次唇裂鼻整形术对与唇裂相关的鼻腔气道阻塞的影响尚未被研究。
确定了 2015 年至 2021 年在费城儿童医院接受二次唇裂鼻整形术的患者。记录了术前和术后的鼻腔阻塞症状评估评分。根据患者特征、手术操作以及术后鼻腔支架情况，评估评分的变化。
二次唇裂鼻整形术前，患者的鼻腔气道阻塞处于轻至中度严重程度。术后，鼻腔阻塞/梗阻、鼻塞、用力时鼻腔通气不足等方面的症状得到改善或缓解（P < 0.05）。总体的鼻腔阻塞症状评估评分也有所改善（P < 0.05）。外侧鼻甲支柱移植与鼻腔阻塞的改善有关，而鼻翼修正和鼻尖缝线与特定的鼻腔症状恶化有关。接受鼻腔支架的患者术后呼吸不畅的报告少于未接受鼻腔支架的患者（P < 0.05）。
唇裂和/或腭裂患者的鼻腔气道阻塞处于轻至中度严重程度，二次唇裂鼻整形术可降低阻塞的主观严重程度。特定的手术操作与鼻腔气道阻塞症状的改变有关，而鼻腔支架与二次唇裂鼻整形术后呼吸不畅的改善有关。
临床问题/证据水平：治疗性，IV 级。
