唇裂外鼻変形患者における鼻修正術に関する比較研究

Abstract

The secondary correction of cleft lip nasal deformity(CLND)presents difficult surgical problems.Characteristically, nostrils are asymmetric. The present study was aimed to examine and compare the effect of Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base for augmentation of the nostril with or without lengthening the columella in CLND.The subjects were 28 patients with unilateral cleft lip, who had secondary nostril correction. The nostril correction methods were Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Yadvancement of the alar base. Facial photographs were taken before and 20days after the operation. By using Adobe photoshop, the columella length and the nostril width were measured from the facial frontal photograph and Worm's eye view. The degree of improvement was calculated and statistically analyzed.The degree of improvement of the columella length using Straith's alar web Z-plasty was 70.20 %. And then Millard's alar web Z-plasty was 55.01 %, alar web excision was 39.93 %, and lateral V-Y advancement of the alar base was 16.38 % in order. The degree of improvement of the nostril size using lateral V-Y advancement of the alar base was 55.26 %. And then alar web excision was 52.72 %, Millard's alar web Z-plasty was 34.86 %, and Straith's alar web Z-plasty was 16.06 % in order. Straith's alar web Z-plasty and Millard's alar web Z-plasty resulted in elongation of the columella, equalization of asymmetrical nostril, and enlargement of small nostrils. Alar web excision enlarged nostrils and restored symmetry. Lateral VY advancement of the alar base increased nostril width and enlarged nostrils.These results indicate that the correction of nostrils improve the shape and the symmetry of the nostrils in CLND.