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Title: [Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery].
Author: Chen M, Guo Z, Yu B.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Jan 15; 38(1):56-61. PubMed ID: 38225842.
Abstract:
OBJECTIVE: To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. METHODS: The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. RESULTS: All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. CONCLUSION: Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery. 目的: 探讨应用自体肋软骨移植结合假体隆鼻进行综合鼻整形术治疗唇裂术后鼻畸形伴鞍鼻畸形患者的临床效果。. 方法: 回顾分析2008年9月—2019年1月收治且符合选择标准的96例唇裂术后鼻畸形伴不同程度鞍鼻畸形患者的临床资料。其中男17例，女79例；年龄17～38岁，平均25.6岁。术中采用自体肋软骨移植构建稳定的鼻尖支架、增强鼻翼软骨强度，鼻背放置假体（膨体39例、硅胶假体45例）或自体肋软骨（12例）行综合鼻整形术治疗。采用疼痛视觉模拟评分（VAS）对术后满意度进行主观评价；计算手术前后鼻翼高度对称指数、鼻翼宽度对称指数、鼻背中轴偏斜角度、鼻小柱偏斜角度进行客观评价。. 结果: 患者均获随访，随访时间6个月～8年，平均13.4个月。术后3例患者出现鼻中隔血肿，予以局部抽吸及鼻腔加压填塞后好转。2例出现鼻背肋软骨移植物轻度变形，其中1例无明显鼻背偏斜，未予以特殊处理；1例取出鼻背移植软骨，更换为硅胶假体。其余患者切口均Ⅰ期愈合，无术后感染、假体移位等并发症发生。术后鼻部形态良好，鼻翼塌陷情况改善，鼻翼高度对称指数、鼻翼宽度对称指数、鼻背中轴偏斜角度、鼻小柱偏斜角度均较术前显著改善，差异有统计学意义（ P<0.05）。术后主观满意度评价均达基本满意及以上程度，非常满意者居多。. 结论: 采用自体肋软骨移植构建稳定鼻尖支架结合鼻背假体或自体软骨植入的综合鼻整形术，矫正唇裂术后鼻畸形伴不同程度鞍鼻畸形可获得良好效果。.

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