Linkugel Andrew D, Mercan Ezgi, Tolley Philip D, Roy Mélissa, Ettinger Russell E, Lo Lun-Jou, Kane Alex A, Tse Raymond W
From the Seattle Children's Hospital.
Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.
Plast Reconstr Surg. 2025 Sep 1;156(3):385e-396e. doi: 10.1097/PRS.0000000000011900. Epub 2024 Nov 26.
Defining the nature of the unilateral cleft lip and palate nasal deformity and its optimal surgical correction continues to be a challenge. The purpose of this study was to develop a data-driven model of the primary unrepaired osseocartilaginous skeleton of the nasomaxillary complex.
Computed tomographic scans of 19 infants aged 3 months with unrepaired unilateral cleft lip and palate and 19 age- and race-matched controls were analyzed. Osseous landmark deviation in subjects with clefts was compared with controls. Segmentation of the osseocartilaginous septum was performed, and deformational differences were calculated between cleft and noncleft cohorts.
Compared with controls, the rhinion, noncleft nasomaxillary junction, and cleft nasomaxillary junction deviated toward the noncleft side. The piriform margins each diverge away from midline with the noncleft side deviating lateral and superior, and the cleft side deviating lateral and posterior. These alterations result in a bony torsion with sigmoidal configuration of the cleft-side aperture, vertical shortening of the central midface, and deprojection of the nasal pyramid. Segmentation of the septum revealed anterior deviation toward the noncleft side with a single convexity toward the cleft.
This 3-dimensional, data-driven model contradicts prior models and confirms a collapsing twist of the cleft-side aperture and medialization of the bony margin of the nasal airway with deviation of the nasal bone complex toward the noncleft side. This analysis defines the critical anatomical characteristics of the cleft nasal deformity and informs the goals of nasal correction at the time of primary repair.
明确单侧唇腭裂鼻畸形的本质及其最佳手术矫正方法仍然是一项挑战。本研究的目的是建立一个基于数据的鼻上颌复合体原发性未修复骨软骨骨架模型。
分析了19例3个月大的单侧唇腭裂未修复婴儿和19例年龄及种族匹配的对照者的计算机断层扫描图像。将腭裂患者的骨性标志偏差与对照组进行比较。对骨软骨鼻中隔进行分割，并计算腭裂组和非腭裂组之间的变形差异。
与对照组相比，鼻根点、非腭裂鼻上颌交界处和腭裂鼻上颌交界处向非腭裂侧偏移。梨状孔边缘均从中线向外分开，非腭裂侧向外上方偏移，腭裂侧向外后方偏移。这些改变导致裂隙侧孔径呈S形的骨性扭转、中央中面部垂直缩短以及鼻锥后缩。鼻中隔分割显示向非腭裂侧前方偏移，向腭裂侧有一个单一的凸度。
这个三维数据驱动模型与先前的模型相矛盾，证实了裂隙侧孔径的塌陷扭转以及鼻气道骨性边缘的内移，鼻骨复合体向非腭裂侧偏移。该分析定义了腭裂鼻畸形的关键解剖特征，并为一期修复时的鼻矫正目标提供了依据。
