Tamada Ikkei, Otaki Marika, Ishikawa Riho
Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
J Plast Reconstr Surg. 2023 Apr 14;2(4):123-128. doi: 10.53045/jprs.2022-0036. eCollection 2023 Oct 27.
The secondary alveolar bone graft (ABG) is one of the key components in the treatment of cleft lip and palate. However, an ABG is commonly accompanied by postoperative facial edema. Although appropriate assessment of facial edema can facilitate the early detection of major postoperative complications, the usual course of swelling post-ABG is not yet fully understood. The present, prospective cohort study was conducted to clarify the typical course of facial swelling post-ABG.
Nineteen operations in 17 patients who underwent an ABG between September 2019 and August 2020 were enrolled. Postoperatively, facial photographs of each patient were taken on four consecutive days; then, the degree of swelling visible in the photographs was assessed by three plastic surgeons. This assessment was repeated one month later.
Both the first and the second assessments demonstrated an inter-rater agreement of 63.2%. Cohen's kappa values for the three possible rater combinations ranged 0.377-0.755 and 0.453-0.574 in the first and the second assessment, respectively. The intra-rater reliability was 77.2%, with a Cohen's kappa value of 0.543, indicating moderate agreement. The swelling peaked on postoperative day 2 and began improving from postoperative day 3.
These findings will hopefully help physicians treating alveolar clefts detect postoperative complications earlier and enable them to explain the prognosis of swelling to patients and their families with greater certainty.
二期牙槽骨植骨术（ABG）是唇腭裂治疗的关键组成部分之一。然而，ABG术后常伴有面部水肿。尽管对面部水肿进行适当评估有助于早期发现主要术后并发症，但ABG术后肿胀的通常过程尚未完全明确。本前瞻性队列研究旨在阐明ABG术后面部肿胀的典型过程。
纳入2019年9月至2020年8月期间接受ABG手术的17例患者的19次手术。术后，连续四天为每位患者拍摄面部照片；然后，由三位整形外科医生评估照片中可见的肿胀程度。一个月后重复此评估。
第一次和第二次评估的评分者间一致性均为63.2%。在第一次和第二次评估中，三种可能的评分者组合的Cohen's kappa值分别在0.377 - 0.755和0.453 - 0.574范围内。评分者内信度为77.2%，Cohen's kappa值为0.543，表明一致性中等。肿胀在术后第2天达到峰值，从术后第3天开始改善。
这些发现有望帮助治疗牙槽裂的医生更早地发现术后并发症，并使他们能够更确切地向患者及其家属解释肿胀的预后情况。
