Department of Plastic Surgery, The First Affiliated Hospital of Bengbu Medical University, 233004 Bengbu, Anhui, China.
Ann Ital Chir. 2024;95(5):816-824. doi: 10.62713/aic.3647.
Due to the diversity and complexity of tissues involved in secondary nasal deformities following unilateral cleft lip, secondary nasal deformity correction surgeries are challenging and often yield unsatisfactory results, posing a difficult problem for plastic surgeons. Autologous cartilage, with its low sculpting difficulty, minimal absorption, and stable tissue compatibility, is considered the optimal material for reconstructing the columella, nasal tip, and alar. This study analyzed the clinical outcomes of using autologous cartilage to create a Y-shaped columella to correct secondary nasal deformities after cleft lip surgery.
In this retrospective study, 75 patients with secondary nasal deformity after unilateral cleft lip surgery were treated from January 2018 to December 2023. Appropriate costal cartilage, auricular cartilage, and iliac crest cartilage were fashioned into Y-shaped stents and implanted into the nasal columella of the patients to strengthen the tip cartilage. The free alar cartilage was sutured and fixed with a Y-shaped bracket. The wound healing rate, subjective satisfaction evaluation, and complications were analyzed. The nasal appearance, nasal deformity classification, and objective indices of healthy and affected nasal sides, function, and quality of life were compared before and after the operation.
All patients healed well during the first stage without related complications, and the average incision healing time was 5.16 ± 1.37 days. The scores of nasal tip position, nasal tip shape, nostril shape, nasal dorsum shape, and nasal floor shape at 6 months post-operation were significantly lower compared to pre-operation (p < 0.001). The grade of nasal deformity at 6 months post-operation was lower than the pre-operation (p < 0.001). Pre-operation, the nasal base and nasal width of the affected side were higher than those of the healthy side, while the nasal columellar and nostril height were lower (p < 0.001). At 6 months post-operation, the nasal base and nasal width decreased, and the nasal columellar and nostril height increased (p < 0.001), with no significant difference between the two sides (p > 0.05). The nasal obstruction symptom evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) scores at 6 months post-operation were significantly lower than pre-operation, while the rhinoplasty outcome evaluation (ROE) score was higher (p < 0.001). The total patient satisfaction was 97.33% (73/75).
Y-shaped nasal columella made of autologous cartilage can effectively correct secondary nasal deformity after cleft lip surgery, improve nasal alar collapse, lengthen nasal columella, elevate nasal end, enhance the quality of life, nasal appearance, and nasal ventilation function of patients, with high satisfaction and few complications.
由于单侧唇裂继发鼻畸形涉及的组织多样且复杂，继发鼻畸形矫正手术具有挑战性，且常导致不满意的结果，这对整形外科医生来说是一个难题。自体软骨具有雕刻难度低、吸收少、组织相容性稳定等优点，被认为是重建鼻中隔、鼻尖和鼻翼的最佳材料。本研究分析了使用自体软骨构建 Y 形鼻中隔矫正单侧唇裂术后继发鼻畸形的临床效果。
本回顾性研究纳入了 2018 年 1 月至 2023 年 12 月间因单侧唇裂术后继发鼻畸形而接受治疗的 75 例患者。合适的肋软骨、耳软骨和髂嵴软骨被塑造成 Y 形支架，并植入患者的鼻中隔以加强鼻尖软骨。游离鼻翼软骨采用 Y 形支架进行缝合和固定。分析患者的伤口愈合率、主观满意度评估以及并发症。比较手术前后患者的鼻部外观、鼻畸形分类、健康侧和患侧的鼻部客观指标（功能和生活质量）。
所有患者在第一阶段均愈合良好，无相关并发症，平均切口愈合时间为 5.16±1.37 天。术后 6 个月时，鼻尖位置、鼻尖形状、鼻孔形状、鼻背形状和鼻底形状评分均显著低于术前（p<0.001）。术后 6 个月时的鼻畸形程度低于术前（p<0.001）。术前，患侧的鼻基底和鼻宽高于健侧，而鼻中隔和鼻孔高度则较低（p<0.001）。术后 6 个月时，鼻基底和鼻宽减小，鼻中隔和鼻孔高度增加（p<0.001），两侧之间无显著差异（p>0.05）。术后 6 个月时的鼻阻塞症状评估（NOSE）和功能性鼻整形术结果问卷-17（FROI-17）评分均显著低于术前，而鼻整形术结果评估（ROE）评分则较高（p<0.001）。患者的总体满意度为 97.33%（73/75）。
自体软骨构建的 Y 形鼻中隔可有效矫正单侧唇裂术后继发鼻畸形，改善鼻翼塌陷，延长鼻中隔，抬高鼻端，提高患者的生活质量、鼻部外观和鼻通气功能，满意度高，并发症少。
