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采用摄影测量分析评估单侧唇裂患者开放式鼻整形术的效果——一项评估性研究。

Outcomes of Open Rhinoplasty for Unilateral Cleft Patients using Photogrammetric Analysis - An Evaluative Study.

作者信息

Elkashty Sherif Mohamed, Taalab Ahmed Abdelaziz, AboShaban Mohammed Saad

机构信息

Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt.

出版信息

Ann Maxillofac Surg. 2023 Jan-Jun;13(1):3-8. doi: 10.4103/ams.ams_34_22. Epub 2023 Jun 15.

DOI:10.4103/ams.ams_34_22
PMID:37711522
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10499273/
Abstract

INTRODUCTION

Secondary cleft rhinoplasty is a challenge due to the complex anatomy of the nose, with structural deformity and difficulty in surgical management. This study aimed to evaluate the effect of an anatomical-based approach on enhancing tip and alar symmetry in secondary unilateral cleft rhinoplasty using photogrammetric evaluation.

METHODS

The study was conducted on 57 adult patients seeking rhinoplasty after primary repair of congenital unilateral cleft lip deformity. All patients were operated upon using an external open rhinoplasty approach using an anatomical-based surgical technique. The cases were periodically followed up at three, six, 12 and 18 months for both aesthetic and functional outcomes with photogrammetric analysis of facial profile using the software Mirror Suite programme to compare before and after the surgical procedure.

RESULTS

The photogrammetric analysis showed a significant improvement of facial angles ( = 0.05). The nasofrontal angle changed from a median of 146° to 132.5°, nasolabial angle of 73° to 95°, nasofacial angle of 21.5° to 32° and nasomental angle of 105° to 130°. The rotation angle of the nasal tip showed a significant cephalic rotation with a mean increase of the tip elongation of 1.8 cm achieved per lateralised millimetre.

DISCUSSION

Secondary rhinoplasty in unilateral cleft deformities needs accurate evaluation of the anatomical and pathological abnormalities. Open approach is preferred with using costal cartilage graft allowing adequate columellar lengthening, maxillary enhancement and alar repositioning which leads to optimise the definition, projection and cephalic rotation with better stabilisation and symmetry of the nasal tip.

摘要

引言

由于鼻子解剖结构复杂，存在结构畸形且手术管理困难，二期鼻整形术具有挑战性。本研究旨在通过摄影测量评估，评价基于解剖学的方法在二期单侧唇裂鼻整形术中增强鼻尖和鼻翼对称性的效果。

方法

本研究对57例先天性单侧唇裂畸形一期修复后寻求鼻整形术的成年患者进行。所有患者均采用基于解剖学手术技术的开放式鼻整形术。通过使用Mirror Suite软件程序对面部轮廓进行摄影测量分析，对病例在术后3个月、6个月、12个月和18个月进行定期随访，以评估美学和功能结果，比较手术前后情况。

结果

摄影测量分析显示面部角度有显著改善（P = 0.05）。鼻额角从中位数146°变为132.5°，鼻唇角从73°变为95°，鼻面角从21.5°变为32°，鼻颏角从105°变为130°。鼻尖旋转角度显示出明显的向上旋转，每向外侧移动1毫米，鼻尖伸长平均增加1.8厘米。

讨论

单侧唇裂畸形的二期鼻整形术需要准确评估解剖和病理异常情况。开放式手术方法更可取，使用肋软骨移植可实现充分的鼻小柱延长、上颌增强和鼻翼重新定位，从而优化鼻尖的清晰度、突出度和向上旋转，实现更好的稳定性和对称性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/4404a8a061b9/AMS-13-3-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/87eca581c969/AMS-13-3-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/20f1d66c0546/AMS-13-3-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/7e7d3c035c9e/AMS-13-3-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/5b4ae4351195/AMS-13-3-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/4404a8a061b9/AMS-13-3-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/87eca581c969/AMS-13-3-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/20f1d66c0546/AMS-13-3-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/7e7d3c035c9e/AMS-13-3-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/5b4ae4351195/AMS-13-3-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e646/10499273/4404a8a061b9/AMS-13-3-g005.jpg

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本文引用的文献

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Costal Cartilage Spring Graft for Late Correction of Cleft Lip Nose Deformity: New Technique.肋软骨弹簧移植物在唇裂鼻畸形后期矫正中的应用：新技术。
Plast Reconstr Surg. 2021 Dec 1;148(6):983e-991e. doi: 10.1097/PRS.0000000000008593.
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Cleft Rhinoplasty.腭裂鼻整形术。
Clin Plast Surg. 2022 Jan;49(1):123-136. doi: 10.1016/j.cps.2021.08.002. Epub 2021 Oct 8.
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Cleft Rhinoplasty: A Tug of War.唇裂鼻整形术：一场拉锯战。
Plast Reconstr Surg Glob Open. 2021 Oct 26;9(10):e3839. doi: 10.1097/GOX.0000000000003839. eCollection 2021 Oct.
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Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity.二期修复术治疗单侧唇裂鼻畸形。
Plast Reconstr Surg. 2021 Jul 1;148(1):133-143. doi: 10.1097/PRS.0000000000008124.
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Surgical Algorithms in Rhinoplasty: A Scoping Review of the Current Status.鼻整形术中的手术算法：当前现状的范围综述。
Aesthetic Plast Surg. 2021 Dec;45(6):2869-2877. doi: 10.1007/s00266-021-02337-w. Epub 2021 May 18.
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The Unilateral Cleft Lip Nasal Deformity: Revisions within 20 Years after Primary Correction.单侧唇裂鼻畸形：初次矫正后 20 年内的修正。
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Cleft Palate Craniofac J. 2021 Aug;58(8):974-983. doi: 10.1177/1055665620980228. Epub 2020 Dec 28.
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