单侧唇裂术后继发鼻畸形分级和术式选择

目的 探讨患者鼻底凹陷的分级,为修复唇裂鼻畸形术后鼻底高度不足的手术方式选择提供参考. 方法 对2008年7月至2009年2月收治的26例单侧唇裂继发鼻畸形的患者,通过三维CT测量上颌骨,结合手术前后鼻部软组织的测量,探讨鼻翼基部软组织和上颌骨的关系,结合患者满意度对鼻畸形进行分级. 结果 鼻翼基部的位置与梨状孔的形态不具有相关性,但鼻翼基部骨缺损与患者的满意度相关,当双侧鼻翼基部凹陷程度＜4.5 mm为1级,仅通过软组织整复即可获得满意的鼻部形态;2级为鼻翼基部凹陷程度介于4.5～5.0 mm,此时可仅进行软组织修复或使用假体充填,具体病例需结合患者要求与临床实际来判断;3级为鼻翼基部凹陷程度＞5 mm,需要联合自体骨或假体的植入或牙槽突裂的整复才能得到满意的效果. 结论 在唇裂术后继发鼻畸形患者中,上颌骨的凹陷并不一定会导致术后鼻翼基部的凹陷,鼻翼基部可以通过手术调整到一个很好的位置.在鼻畸形矫正术前需要结合患者鼻部的测量来选择手术方式,以得到满意的效果.

Abstract：

Objective To investigate the classification of alar base depression,so as to provide the reference for the surgical management of secondary nasal deformity of unilateral cleft lip. Methods From Jul.2008 to Feb.2009,26 cases with sceondary deformity of unilateral cleft lip were treated.All the patients underwent 3-dimensional CT for maxillary measurement.The nasal soft tissue measurement was performed pre-and post-operatively.The relationship between the maxillary and soft tissue at alar base was analyzed.The nasal deformity was classified. Results The location of alar base was not related to the form of piriform aperture,but the bony defect at the alar base was correlated to the patient satisfactory.The nasal deformity was graded as Ⅰ when the depression at alar base was less than 4.5 mm in depth,as Ⅱ when it was 4.5-5.0 mm in depth,and as Ⅲ when it was more than 5 mm in depth.The deformity could be corrected with only soft tissue plasty for grade Ⅰ,with soft tissue plasty or artificial implants for grade Ⅱ,with combined bone autograft or alveolar cleft repair for grade Ⅲ. Conclusions The depression at maxillary does not necessarily result in alar base depression.The alar base can be adjust to proper position through operation.The operation should be designed based on the preoperative nasal measurement.

Classification and surgical management of secondary nasal deformity of unilateral cleft lip

Objective To investigate the classification of alar base depression,so as to provide the reference for the surgical management of secondary nasal deformity of unilateral cleft lip. Methods From Jul.2008 to Feb.2009,26 cases with sceondary deformity of unilateral cleft lip were treated.All the patients underwent 3-dimensional CT for maxillary measurement.The nasal soft tissue measurement was performed pre-and post-operatively.The relationship between the maxillary and soft tissue at alar base was analyzed.The nasal deformity was classified. Results The location of alar base was not related to the form of piriform aperture,but the bony defect at the alar base was correlated to the patient satisfactory.The nasal deformity was graded as Ⅰ when the depression at alar base was less than 4.5 mm in depth,as Ⅱ when it was 4.5-5.0 mm in depth,and as Ⅲ when it was more than 5 mm in depth.The deformity could be corrected with only soft tissue plasty for grade Ⅰ,with soft tissue plasty or artificial implants for grade Ⅱ,with combined bone autograft or alveolar cleft repair for grade Ⅲ. Conclusions The depression at maxillary does not necessarily result in alar base depression.The alar base can be adjust to proper position through operation.The operation should be designed based on the preoperative nasal measurement.