Fukuyama Sotatsu, Saito Takafumi, Lo Lun-Jou
From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital and Chang Gung University.
Plast Reconstr Surg. 2025 Jun 1;155(6):1015e-1026e. doi: 10.1097/PRS.0000000000011728. Epub 2024 Sep 4.
Patients with unilateral cleft lip and palate (UCLP) could present with a notable nasal deformity with alar base retrusion, which should be considered when planning orthognathic surgery.
This retrospective study included 84 patients with class III malocclusion. Cone beam computed tomographic data were used for the investigation. A total of 42 patients had complete UCLP, and the other 42 did not have a cleft. All the patients underwent preoperative virtual surgical planning. Preoperative and postoperative images were used to measure anteroposterior changes in the bone and soft tissue at the alar bases.
In the UCLP group, varying degrees of alar base discrepancies were observed before surgery. In the piriform region of the cleft side, the bone was retruded in 32 cases, but the soft tissue was thicker in 38 cases, and the mean skin surface was anterior in 28 cases. After surgery, the bone discrepancy was not significantly changed ( P = 0.288); however, the skin surface symmetry was improved ( P = 0.013). Relating to the bone advancement, the ratio of soft-tissue change was smaller on the cleft side than the noncleft side (0.56 ± 0.30 versus 0.77 ± 0.33; P < 0.001). In the control group, a consistent ratio change was observed on both sides (0.76 ± 0.19 versus 0.79 ± 0.27; P = 0.544).
This study revealed improved alar-base symmetry in patients with UCLP after orthognathic surgery. The soft-tissue change ratios were different across the cleft, which should be considered during treatment planning.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
单侧唇腭裂（UCLP）患者可能存在明显的鼻畸形，伴有鼻翼基底后缩，在计划正颌手术时应予以考虑。
这项回顾性研究纳入了84例III类错牙合患者。使用锥形束计算机断层扫描数据进行研究。共有42例患者患有完全性UCLP，另外42例没有腭裂。所有患者均接受了术前虚拟手术规划。术前和术后图像用于测量鼻翼基底处骨骼和软组织的前后变化。
在UCLP组中，术前观察到不同程度的鼻翼基底差异。在裂隙侧的梨状区域，32例骨骼后缩，但38例软组织较厚，28例平均皮肤表面靠前。术后，骨骼差异无明显变化（P = 0.288）；然而，皮肤表面对称性得到改善（P = 0.013）。与骨骼前移相关，裂隙侧软组织变化率小于非裂隙侧（0.56±0.30对0.77±0.33；P < 0.001）。在对照组中，两侧观察到一致的比率变化（0.76±0.19对0.79±0.27；P = 0.544）。
本研究显示正颌手术后UCLP患者的鼻翼基底对称性得到改善。裂隙两侧的软组织变化率不同，在治疗计划中应予以考虑。
临床问题/证据水平：治疗性，IV级。
