Application of autologous costal cartilage-based open rhinoplasty in secondary unilateral cleft lip nasal deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

REN Pengjie ,  FAN Fei , ZHENG Ruobing , XU Yihao , YOU Jianjun , WANG Huan , ZHANG Xulong , TIAN Le , LIN Guangxian

Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100043, P.R.China;

Corresponding?author：

FAN Fei, Email: fanfei1962@gmail.com

Keywords：

Autologous costal cartilage; rhinoplasty; unilateral cleft lip; secondary cleft lip nasal deformity

DOI：

10.7507/1002-1892.202012066

Video：

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Objective To evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.Methods Between January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).Results The incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.Conclusion Autologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.

Citation： REN Pengjie, FAN Fei, ZHENG Ruobing, XU Yihao, YOU Jianjun, WANG Huan, ZHANG Xulong, TIAN Le, LIN Guangxian. Application of autologous costal cartilage-based open rhinoplasty in secondary unilateral cleft lip nasal deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1021-1026. doi: 10.7507/1002-1892.202012066 Copy

1.	安陽, 李東. 單側唇裂修復術后繼發鼻畸形治療的研究進展. 中國美容整形外科雜志, 2017, 28(9): 569-571.
2.	陶凱. 唇腭裂術后鼻整形的辯證法. 中國美容整形外科雜志, 2014, 25(4): 255-256.
3.	吳卓霞, 張連波. 唇腭裂繼發鼻畸形的診斷治療進展. 中華醫學美學美容雜志, 2015, 21(2): 125-127.
4.	Allori AC, Mulliken JB. Evidence-based medicine: Secondary correction of cleft lip nasal deformity. Plast Reconstr Surg, 2017, 140(1): 166e-176e.
5.	Han YP, Li CH, Shi B, et al. Establishment of new asymmetrical grafts in secondary nasal deformity repair. Plast Reconstr Surg, 2019, 144(5): 938e-939e.
6.	石冰. 中國人唇裂鼻畸形整復的思路與術式設計. 華西口腔醫學雜志, 2012, 30(2): 111-114, 118.
7.	鄭永生, 陳宗基, 孫強, 等. 鼻翼軟骨肌肉環的修復在唇裂鼻畸形中的作用. 整形再造外科雜志, 2005, 2(2): 79-81, 85.
8.	李海東, 尹寧北, 宋濤, 等. 鼻翼軟骨離斷術矯正單側唇裂術后鼻畸形. 中國美容醫學, 2010, 19(z3): 14-15.
9.	張斌, 劉強, 劉昆, 等. 肋軟骨支架與顆粒肋軟骨聯合移植在單側唇裂鼻畸形整復中的應用研究. 中國美容整形外科雜志, 2013, 24(12): 723-725.
10.	成鋌, 趙敏, 王秉政, 等. 伴有齒槽嵴裂的單側唇裂術后繼發鼻畸形的修復. 中國實用美容整形外科雜志, 2006, 17(3): 176-178.
11.	Liu CS, Hsiao YC, Huang JJ, et al. Secondary unilateral cleft rhinoplasty using natural curvature of rib cartilage as alar rim graft: A three-dimensional evaluation of long-term results. Plast Reconstr Surg, 2020, 145(3): 775-779.
12.	Zhou F, Lin W, Du Y, et al. Single-stage repair of secondary unilateral cleft lip-nose deformity in adults. J Craniomaxillofac Surg, 2020, 48(1): 83-89.
13.	梁瑛, 王先成, 孫揚, 等. 顆粒軟骨在唇裂術后鼻畸形中的應用. 中華整形外科雜志, 2020, 36(1): 49-52.
14.	Zhang L, Bai X, Li Z, et al. Improvement of aesthetic and nasal airway in patients with cleft lip nasal deformities: rhinoplasty with septal cartilage graft and septoplasty. Cleft Palate Craniofac J, 2018, 55(4): 554-561.
15.	趙麗, 顧斌, 毋磊. 應用自體耳軟骨綜合矯正唇裂繼發鼻畸形. 中華整形外科雜志, 2015, 31(2): 138-139.
16.	Chen H, Chen CY, Fang QQ, et al. Computed tomography-assisted auricular cartilage graft for depression of the alar base in secondary unilateral cleft lip repair: A preliminary report. Cleft Palate Craniofac J, 2019, 56(1): 39-45.
17.	楊斌, 趙敏, 熊斌, 等. 單側齒槽嵴裂植骨與唇鼻畸形的同期整復. 臨床口腔醫學雜志, 2009, 25(5): 299-300.
18.	徐奕昊, 范飛, 尤建軍, 等. 精細構建鼻再造術中軟骨支架的效果. 中華醫學美學美容雜志, 2020, 26(2): 123-126.
19.	Farkas LG, Kolar JC, Munro IR. Geography of the nose: a morphometric study. Aesthetic Plast Surg, 1986, 10(4): 191-223.
20.	Mercan E, Oestreich M, Fisher DM, et al. Objective assessment of the unilateral cleft lip nasal deformity using three-dimensional stereophotogrammetry: Severity and outcome. Plast Reconstr Surg, 2018, 141(4): 547e-558e.
21.	Yeow VK, Chen PK, Chen YR, et al. The use of nasal splints in the primary management of unilateral cleft nasal deformity. Plast Reconstr Surg, 1999, 103(5): 1347-1354.

1. 安陽, 李東. 單側唇裂修復術后繼發鼻畸形治療的研究進展. 中國美容整形外科雜志, 2017, 28(9): 569-571.
2. 陶凱. 唇腭裂術后鼻整形的辯證法. 中國美容整形外科雜志, 2014, 25(4): 255-256.
3. 吳卓霞, 張連波. 唇腭裂繼發鼻畸形的診斷治療進展. 中華醫學美學美容雜志, 2015, 21(2): 125-127.
4. Allori AC, Mulliken JB. Evidence-based medicine: Secondary correction of cleft lip nasal deformity. Plast Reconstr Surg, 2017, 140(1): 166e-176e.
5. Han YP, Li CH, Shi B, et al. Establishment of new asymmetrical grafts in secondary nasal deformity repair. Plast Reconstr Surg, 2019, 144(5): 938e-939e.
6. 石冰. 中國人唇裂鼻畸形整復的思路與術式設計. 華西口腔醫學雜志, 2012, 30(2): 111-114, 118.
7. 鄭永生, 陳宗基, 孫強, 等. 鼻翼軟骨肌肉環的修復在唇裂鼻畸形中的作用. 整形再造外科雜志, 2005, 2(2): 79-81, 85.
8. 李海東, 尹寧北, 宋濤, 等. 鼻翼軟骨離斷術矯正單側唇裂術后鼻畸形. 中國美容醫學, 2010, 19(z3): 14-15.
9. 張斌, 劉強, 劉昆, 等. 肋軟骨支架與顆粒肋軟骨聯合移植在單側唇裂鼻畸形整復中的應用研究. 中國美容整形外科雜志, 2013, 24(12): 723-725.
10. 成鋌, 趙敏, 王秉政, 等. 伴有齒槽嵴裂的單側唇裂術后繼發鼻畸形的修復. 中國實用美容整形外科雜志, 2006, 17(3): 176-178.
11. Liu CS, Hsiao YC, Huang JJ, et al. Secondary unilateral cleft rhinoplasty using natural curvature of rib cartilage as alar rim graft: A three-dimensional evaluation of long-term results. Plast Reconstr Surg, 2020, 145(3): 775-779.
12. Zhou F, Lin W, Du Y, et al. Single-stage repair of secondary unilateral cleft lip-nose deformity in adults. J Craniomaxillofac Surg, 2020, 48(1): 83-89.
13. 梁瑛, 王先成, 孫揚, 等. 顆粒軟骨在唇裂術后鼻畸形中的應用. 中華整形外科雜志, 2020, 36(1): 49-52.
14. Zhang L, Bai X, Li Z, et al. Improvement of aesthetic and nasal airway in patients with cleft lip nasal deformities: rhinoplasty with septal cartilage graft and septoplasty. Cleft Palate Craniofac J, 2018, 55(4): 554-561.
15. 趙麗, 顧斌, 毋磊. 應用自體耳軟骨綜合矯正唇裂繼發鼻畸形. 中華整形外科雜志, 2015, 31(2): 138-139.
16. Chen H, Chen CY, Fang QQ, et al. Computed tomography-assisted auricular cartilage graft for depression of the alar base in secondary unilateral cleft lip repair: A preliminary report. Cleft Palate Craniofac J, 2019, 56(1): 39-45.
17. 楊斌, 趙敏, 熊斌, 等. 單側齒槽嵴裂植骨與唇鼻畸形的同期整復. 臨床口腔醫學雜志, 2009, 25(5): 299-300.
18. 徐奕昊, 范飛, 尤建軍, 等. 精細構建鼻再造術中軟骨支架的效果. 中華醫學美學美容雜志, 2020, 26(2): 123-126.
19. Farkas LG, Kolar JC, Munro IR. Geography of the nose: a morphometric study. Aesthetic Plast Surg, 1986, 10(4): 191-223.
20. Mercan E, Oestreich M, Fisher DM, et al. Objective assessment of the unilateral cleft lip nasal deformity using three-dimensional stereophotogrammetry: Severity and outcome. Plast Reconstr Surg, 2018, 141(4): 547e-558e.
21. Yeow VK, Chen PK, Chen YR, et al. The use of nasal splints in the primary management of unilateral cleft nasal deformity. Plast Reconstr Surg, 1999, 103(5): 1347-1354.

Chinese Journal of Reparative and Reconstructive Surgery

Application of autologous costal cartilage-based open rhinoplasty in secondary unilateral cleft lip nasal deformity

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