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.	安阳, 李东. 单侧唇裂修复术后继发鼻畸形治疗的研究进展. 中国美容整形外科杂志, 2017, 28(9): 569-571.
2.	陶凯. 唇腭裂术后鼻整形的辩证法. 中国美容整形外科杂志, 2014, 25(4): 255-256.
3.	吴卓霞, 张连波. 唇腭裂继发鼻畸形的诊断治疗进展. 中华医学美学美容杂志, 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. 中国人唇裂鼻畸形整复的思路与术式设计. 华西口腔医学杂志, 2012, 30(2): 111-114, 118.
7.	郑永生, 陈宗基, 孙强, 等. 鼻翼软骨肌肉环的修复在唇裂鼻畸形中的作用. 整形再造外科杂志, 2005, 2(2): 79-81, 85.
8.	李海东, 尹宁北, 宋涛, 等. 鼻翼软骨离断术矫正单侧唇裂术后鼻畸形. 中国美容医学, 2010, 19(z3): 14-15.
9.	张斌, 刘强, 刘昆, 等. 肋软骨支架与颗粒肋软骨联合移植在单侧唇裂鼻畸形整复中的应用研究. 中国美容整形外科杂志, 2013, 24(12): 723-725.
10.	成铤, 赵敏, 王秉政, 等. 伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复. 中国实用美容整形外科杂志, 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, 孙扬, 等. 颗粒软骨在唇裂术后鼻畸形中的应用. 中华整形外科杂志, 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.	赵丽, 顾斌, 毋磊. 应用自体耳软骨综合矫正唇裂继发鼻畸形. 中华整形外科杂志, 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.	杨斌, 赵敏, 熊斌, 等. 单侧齿槽嵴裂植骨与唇鼻畸形的同期整复. 临床口腔医学杂志, 2009, 25(5): 299-300.
18.	徐奕昊, 范飞, 尤建军, 等. 精细构建鼻再造术中软骨支架的效果. 中华医学美学美容杂志, 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. 安阳, 李东. 单侧唇裂修复术后继发鼻畸形治疗的研究进展. 中国美容整形外科杂志, 2017, 28(9): 569-571.
2. 陶凯. 唇腭裂术后鼻整形的辩证法. 中国美容整形外科杂志, 2014, 25(4): 255-256.
3. 吴卓霞, 张连波. 唇腭裂继发鼻畸形的诊断治疗进展. 中华医学美学美容杂志, 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. 中国人唇裂鼻畸形整复的思路与术式设计. 华西口腔医学杂志, 2012, 30(2): 111-114, 118.
7. 郑永生, 陈宗基, 孙强, 等. 鼻翼软骨肌肉环的修复在唇裂鼻畸形中的作用. 整形再造外科杂志, 2005, 2(2): 79-81, 85.
8. 李海东, 尹宁北, 宋涛, 等. 鼻翼软骨离断术矫正单侧唇裂术后鼻畸形. 中国美容医学, 2010, 19(z3): 14-15.
9. 张斌, 刘强, 刘昆, 等. 肋软骨支架与颗粒肋软骨联合移植在单侧唇裂鼻畸形整复中的应用研究. 中国美容整形外科杂志, 2013, 24(12): 723-725.
10. 成铤, 赵敏, 王秉政, 等. 伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复. 中国实用美容整形外科杂志, 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, 孙扬, 等. 颗粒软骨在唇裂术后鼻畸形中的应用. 中华整形外科杂志, 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. 赵丽, 顾斌, 毋磊. 应用自体耳软骨综合矫正唇裂继发鼻畸形. 中华整形外科杂志, 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. 杨斌, 赵敏, 熊斌, 等. 单侧齿槽嵴裂植骨与唇鼻畸形的同期整复. 临床口腔医学杂志, 2009, 25(5): 299-300.
18. 徐奕昊, 范飞, 尤建军, 等. 精细构建鼻再造术中软骨支架的效果. 中华医学美学美容杂志, 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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