口唇口蓋裂症例におけるＬｅ Ｆｏｒｔ Ｉ型骨切り術と鼻形成術の施行順序に関する検討

Abstract

In cleft lip and palate patients, functional and esthetic correction of severe dentofacial deformity may require not only Le Fort I maxillary osteotomy but also rhinoplasty.We investigated the order of these two kinds of surgeries in 6 cases with cleft lip and palate. In three cases, Le Fort I maxillary advancement was preceded by open rhinoplasty with a cantilever iliac bone graft (Group A). In the other 3 cases, open rhinoplasty was preceded by Le Fort I maxillary advancement (Group B). The changes of nasal tip protrusion, the nasolabial angle, and the nostril form were evaluated in nasal morphology. Measurements were performed using facial photographs and lateral cephalograms.In group A, nasal tip protrusion was decreased after the two surgeries. On the other hand, it was clearly increased after the two surgeries in group B. The nasolabial angle showed various change patterns in both groups. The final nostril form was better in group B than in group A. These results suggested that open rhinoplasty with a cantilever iliac bone graft before Le Fort I maxil lary advancement may lead to a better surgical outcome in nasal shape.