From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital.
Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique.
Plast Reconstr Surg. 2024 Mar 1;153(3):605e-611e. doi: 10.1097/PRS.0000000000010548. Epub 2023 Apr 13.
Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology.
Consecutive young adult patients ( n = 13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for three-dimensional morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale.
Three-dimensional morphometric analysis revealed a significant (all P < 0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference ( P > 0.05) between cleft and noncleft sides. The postoperative three-dimensional projection of the philtral ridges was significantly ( P < 0.001) larger in cleft (1.01 ± 0.43 mm) than in noncleft sides (0.51 ± 0.42 mm). The average philtrum volume change was 1.01 ± 0.68 cm 3 , with an average percentage fat graft retention of 43.36% ± 11.35%. The panel assessment revealed significant ( P < 0.001) postoperative scar enhancement for the qualitative rating scale, with mean preoperative and postoperative scores of 6.69 ± 0.93 and 7.88 ± 1.14, respectively.
Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
改善继发唇裂畸形患者的人中形态一直是唇裂治疗的挑战。皮内 rigottomy 联合脂肪移植已被用于治疗与瘢痕受区相关的容积不足。本研究评估了同步脂肪移植和 rigottomy 改善唇裂人中形态的效果。
连续纳入 13 例接受单侧唇裂修复的年轻成年患者，采用脂肪移植联合 rigottomy 扩张技术改善人中形态。术前和术后三维面部模型用于三维形态计量分析，包括人中高度、突出度和体积参数。由两位盲法外部整形外科医生组成的小组使用 10 分制视觉模拟量表对唇瘢痕进行定性判断。
三维形态计量分析显示，唇裂人中高度、非唇裂人中高度和中央唇长度相关测量值在术后均有显著（均 P < 0.05）增加，且裂侧与非裂侧之间无差异（ P > 0.05）。人中嵴的术后三维投影在裂侧（1.01 ± 0.43 mm）显著大于非裂侧（0.51 ± 0.42 mm）（ P < 0.001）。人中体积变化平均为 1.01 ± 0.68 cm 3 ，平均脂肪移植保留率为 43.36% ± 11.35%。专家组评估显示，瘢痕定性评分显著改善（ P < 0.001），术前和术后平均评分为 6.69 ± 0.93 和 7.88 ± 1.14。
同步脂肪移植和 rigottomy 改善了单侧唇裂修复患者的人中长度、突出度和体积，以及唇瘢痕。
临床问题/证据水平：治疗，IV。
