小児期の片側性唇裂外鼻二次修正術の臨床的・三次元的観察

Abstract

Objective: To analyze the outcomes of the secondary correction of unilateral cleft lip nose deformities in childhood, the preoperative and postoperative nasal forms were assessed clinically and three-dimensionally. Patients and methods: Fifteen Japanese children with unilateral complete cleft lip with/without cleft palate (UCLP) who had undergone follow-up secondary cleft lip nose correction in childhood and were followedup for 2 to 4 years at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital were studied. All patients were treated by rhinoplasty through a unilateral reverse-U incision combined with the medial-upward advancement of nasolabial components and vestibular expansion using a free mucosal graft. Three-dimensional (3D) nasal forms were longitudinally measured using a 3D noncontact laser scanner preoperatively and 3 months and more than 2 year postoperatively in 6 patients. Analyzed variables included angular and linear measurements, deviation of the nasal midline, and curvature of the nasal alar. Results: There were no serious complications in any patients. Comparison of the preoperative and postoperative 3D nasal forms revealed that the nasal height was significantly increased (p<0.05) and the deviation of the nasal midline was improved in the lower half of the nose (p<0.05) postoperatively. The significant difference in the curvature of the nasal alar grooves between the cleft and noncleft sides (p<0.05) disappeared postoperatively. However, longitudinal observation of the nasal forms demonstrated slight relapse of the nasal height and nostril shape more than 2 years postoperatively. Conclusions: Our procedure for secondary correction of nasal deformities in childhood improves the nasal height and symmetry of the alar forms of patients with UCLP. Long-term follow-up is necessary to clarify effects on the stability and growth of nasal tissues reconstructed in childhood.