NAMによる術前矯正と鼻口唇一体移動による低侵襲初回片側性唇裂外鼻修正の取り組み

Abstract

Despite recent developments in cleft surgery, management of primary unilateral cleft lip nose deformity has not yet been established. In this article, our treatment of nose deformity in an infant with unilateral cleft lip and palate (UCLP) by presurgical nasoalveolar molding (NAM) followed by primary cleft lip and nose repair is described.The authors performed relatively radical treatment of unilateral cleft nose deformity by repositioning the lower lateral nasal cartilage after dissecting it from the skin and/or lining through a nostril rim incision in the 1990s. Although outcomes achieved by the above procedures were acceptable, it was difficult to handle an infant's fragile cartilage even with open dissection. Recently, we adopted NAM for successful presurgical alignment of alveolar bone and correction of nasal deformity by medial and upward advancement of the nasolabial components to reposition the nasalis muscle and orbicularis oris muscle. These procedures result in more consistent postoperative outcomes.To assess the results of our treatment for UCLP nose deformity, the nasal forms of fifteen patients with complete UCLP (correction group) who were treated and followed for more than 1 year (1-5 years) were compared to those of 15 patients who did not undergo primary rhinoplasty (no correction group). All subjects of the correction group underwent presurgical orthopedic treatment with NAM, followed by lip repair using Cronin's triangular flap method with medial-upward advancement of nasolabial components with vestibular expansion using the cleft margin flap. Postoperative nasal forms including nostril height and width ratio, ratio of the height of the top of the alar groove, and curvature of the appropriate circle of the nasal alar groove were evaluated using color photos. Comparison of postoperative nasal forms demonstrated that the nostril height and width ratio and the height of the top of the alar groove in the correction group were significantly superior compared to those in the no correction group.Our management of cleft lip nose provides a good nasal form with minimum invasion in patients with UCLP. Long-term follow-up will be necessary to clarify effects on the growth of nasal tissues reconstructed in infancy. Furthermore, additional improvements in the technique of presurgical molding of deformed facial bones will be required in order to ensure a stable postoperative result.