Sakamoto Yoshiaki, Miyamoto Junpei, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo.
Miyamoto Plastic and Reconstructive Surgery Hospital, Danbaraminami, Minami-ku, Horoshima-shi, Hiroshima, Japan.
J Craniofac Surg. 2023 Oct 1;34(7):2129-2132. doi: 10.1097/SCS.0000000000009577. Epub 2023 Aug 15.
The effects of operative intervention on vertical nasal growth in patients with unilateral cleft lips (CLs) are well described. However, the factors influencing nasal symmetry have not been sufficiently evaluated. Therefore, this study aimed to study the factors that cause difficulties in obtaining nasal symmetry postoperatively in patients with CLs. We conducted a retrospective analysis using data from patients with CLs who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on the patients' sex, cleft type, number and time of revision surgery, palatal fistula incidence, and history of the pharyngeal flap and orthognathic surgery. Nasal symmetry was analyzed as the symmetrical ratio after the final touch-up surgery, and multivariate analysis was conducted using binary logistic regression to determine the factors affecting nasal symmetry. This study included 89 patients with unilateral CL. Multivariate analysis revealed that complete cleft lip and palate ( P < 0.05, odds ratio = 4.37) and repeated revision surgery ( P < 0.05, odds ratio = 9.28) were significant predictors of the final nasal symmetry. Our study showed that cleft type and the number of revision surgeries were identified as important factors for obtaining nasal symmetry after final touch-up rhinoplasty. Revision surgery may be necessary to relieve patients' psychological stress due to nasal deformity, suggesting that this dilemma needs to be overcome.
手术干预对单侧唇裂（CL）患者垂直鼻生长的影响已有详尽描述。然而，影响鼻对称性的因素尚未得到充分评估。因此，本研究旨在探究导致CL患者术后难以实现鼻对称性的因素。我们对1990年至2000年在庆应义塾大学医院接受一系列治疗的CL患者数据进行了回顾性分析。我们收集了患者的性别、腭裂类型、修复手术次数和时间、腭瘘发生率以及咽瓣和正颌手术史等数据。鼻对称性通过最后一次微调手术后的对称率进行分析，并使用二元逻辑回归进行多变量分析以确定影响鼻对称性的因素。本研究纳入了89名单侧CL患者。多变量分析显示，完全性唇腭裂（P < 0.05，优势比 = 4.37）和反复修复手术（P < 0.05，优势比 = 9.28）是最终鼻对称性的显著预测因素。我们的研究表明，腭裂类型和修复手术次数被确定为最终鼻整形微调术后实现鼻对称性的重要因素。修复手术对于缓解患者因鼻畸形产生的心理压力可能是必要的，这表明这种困境需要被克服。
