- 期刊
Columella Lengthening in Bilateral Cleft Lip Nasal Deformity-Comparison of Five Different Methods
雙側性唇裂鼻部變形的鼻小柱延長手術－比較五種不同術式的結果
摘要
背景： 雙側唇裂的病人無可避免會導致鼻部變形。目前對於第一階段或第二階段施行鼻小柱延長手術仍有爭議；另外也缺乏第二階段鼻小柱延長手術的比較性研究。 目的及目標： 這篇研究的主要目的在比較五種鼻小柱延長手術(primary columella lengthening using island C-flap, the forked-flap method, composite graft, the Cronin's method, and open-tip V-Y rhinoplasty)的美觀結果與再手術比率。 材料及方法： 在二十年的時間內，我們追蹤於林口長庚醫院顱顏中心146個因雙側唇裂鼻部變形而接受鼻小柱延長手術的病人。追蹤時間至少6個月；這些病人在接受評估時的年紀分佈在4歲8個月到30歲之間。評估美觀時我們使用三分評分系統：3分表示很好的結果，2分表示一般的結果需要些微的修改手術，1分表示差的結果且需要較大的修改手術。共有38個病人需接受再次手術；我們記錄並用統計方式來比較108個沒有接受再手術的病人的初步結果與全部146個病人的最後結果。 結果： 在各組之中，需接受再次手術來矯正鼻部變形的比例最高的是52% (primary columella lengthening)，而最低的是5% (open-tip V-Y rhinoplasty)。在108個沒有接受再次手術的病人的初步結果中，複合式移植(composite graft)的美觀結果最差（平均分數1.69），開放式V-Y鼻整形(open-tip V-Y rhinoplasty)可以得到最好的美觀結果（平均分數2.6）。在全部146個病人的最後結果中，同樣是複合式移植(composite graft)的結果最差，而開放式V-Y鼻整形(open-tip V-Y rhinoplasty)同樣可以得到最好的結果（平均分數2.62），且有統計上顯著意義。 結論： 在雙側性唇裂鼻部變形的重建時，初級鼻小柱延長術(primary columella lengthening using island C-flap)因為有很高的再手術比例，我們不建議採用。而在我們研究所採用的四種第二階段鼻小柱延長手術中，開放式V-Y鼻整形(open-tip V-Y rhinoplasty)可得到最好美觀上的結果與最少的再手術比例，應被視為首選的方式。
關鍵字
無資料並列摘要
Background: Patients with bilateral cleft lip often have nasal deformity. Controversy regarding primary versus secondary columella lengthening in terms of cosmetic outcome remain unsolved. Furthermore, there are few comparative studies to evaluate different methods for secondary columella lengthening. Aim and Objectives: The purpose of the study is to compare 5 different columella lengthening surgery (primary columella lengthening using island C-flap, the forked-flap method, composite graft, the Cronin's method, and open-tip V-Y rhinoplasty) in terms of the aesthetic result and revision rate. Materials and method: Within a period of 20 years, we retrospectively reviewed 146 patients with bilateral cleft nasal deformity undergoing columella lengthening surgery using one of the five above-mentioned techniques. The minimum follow-up period was 6 months and the patient age at final evaluation ranged from 4 years 8 months to 30 years. Aesthetic outcome was evaluated using 3 point scoring system as follows: 3 points indicating good result, 2 points indicating average result and 1 point indicating poor result. Thirty eight of all patients underwent repeated revisions; the primary aesthetic results of the 108 patients without revisions and the final aesthetic results of all 146 patients were recorded and mean scores were obtained for statistic analyses. Results: For aesthetic results, there was statistical significance among groups; the composite graft group had the worst aesthetic result with a mean score of 1.69 and open-tip V-Y rhinoplasty yielded the best results with a mean aesthetic score of 2.60. The rate of repeated revisions ranged from 5% (open-tip) to 52% (primary columella lengthening using island C-flap). For final aesthetic results, there was also statistical significance among groups; open-tip V-Y rhinoplasty was also superior in final aesthetic results (mean score=2.62) Conclusions: Because of its high revision rate, island C-flap primary columella lengthening is not recommended as a routine procedure for patients with bilateral cleft lip. As for the four secondary columella lengthening techniques used in our patients, open-tip rhinoplasty achieves best aesthetic result, has lowest rate of revision and should be considered as the option of choice.