Individualized surgical management of secondary rhinoplasty for cleft lip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHILungang ,  TANGShijie , XIESitian , PENGLihong

Department of Plastic Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou Guangdong, 515041, P. R. China;

Corresponding author：

TANGShijie, Email: tang2302@163.com

Keywords：

Cleft lip; Nasal deformity; Autologous costal cartilage; Individualized surgical management

DOI：

10.7507/1002-1892.20160175

Video：

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Objective To explore the effectiveness of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip. Methods Between September 2009 and January 2014, 350 patients with secondary nasal deformity of cleft lip were treated, including 160 males and 190 females with a mean age of 18.2 years (range, 16-56 years). Nasal deformity was caused by unilateral cleft lip in 200 cases and by bilateral cleft lip in 150 cases. The interval of lip repair and nasal deformity correction was 2-50 years (mean, 12 years). About a 2-6 cm cartilage was harvested from the 6th or 7th costal cartilage, and was engraved to the shape of "ge" in Chinese. The upper part was strengthened on both sides of the alar cartilage; the lower part was fastened to columella and nasal septum cartilages. The rest of cartilages was diced into 0.1 mm×0.1 mm×0.1 mm cubes. The columella incision was designed to "Z"-plasty, and was stretched to the nasion along alar edge. The engraved autologous costal cartilage was transplanted and fixed to the collapse of nostril. The cartilage cube was transplanted and filled into the collapse of nasal root to achieve the aesthetic effect of nasal augmentation. The effectiveness was evaluated according to the grade of secondary rhinoplasty for cleft lip by ZHANG Li et al. at 1, 6, and 12 months after operation. Results All incisions were primary healing. All patients were followed up 1-12 months (mean, 6 months). After rhinoplasty, the collapse of nostrils was lifted, and the shape and height of collapse of nostrils were symmetrical to normal side. The deflection of columella nasi was corrected. A beautiful shape of nose was achieved. The excellent and good rates were 98.6% at 1 month, 97.4% at 6 months, and 97.1% at 12 months after operation, showing no significant difference (χ²=0.545, P=0.761). Conclusion The technique of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip can achieve excellent surgery effect.

Citation： SHILungang, TANGShijie, XIESitian, PENGLihong. Individualized surgical management of secondary rhinoplasty for cleft lip. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 861-865. doi: 10.7507/1002-1892.20160175 Copy

1.	王苗苗, 李毅.唇裂鼻畸形的研究现状.组织工程与重建外科杂志, 2009, 5(4): 235-237.
2.	Gassling V, Koos B, Birkenfeld F, et al. Secondary cleft nose rhinoplasty: Subjective and objective outcome evaluation. J Craniomaxillofac Surg, 2015, 43(9): 1855-1862.
3.	Lonic D, Morris DE, Lo LJ. Primary overcorrection of the unilateral cleft nasal deformity: quantifying the results. Ann Plast Surg, 2016. [Epub ahead of print].
4.	张莉, 程新德, 朱云琳, 等.单侧唇裂继发鼻畸形的临床修复体会.中国美容医学, 2015, 24(3): 19-22.
5.	Masuoka H, Kawai K, Morimoto N, et al. Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities. J Plast Reconstr Aesthet Surg, 2012, 65(7): 857-863.
6.	Lünenbürger H, Roknic N, Klein M, et al. Treatment outcome of the transfacial titanium epiplating system for total nasal defects. Plast Reconstr Surg, 2016, 137(2): 405e-413e.
7.	肖文芝, 刘华, 陈涌, 等.单侧唇裂继发鼻畸形的临床整复.中国美容医学, 2014, 23(3): 183-186.
8.	Wolfe SA, Nathan NR, MacArthur IR. The cleft lip nose: primary and secondary treatment. Clin Plast Surg, 2016, 43(1): 213-221.
9.	Farouk A. Rhinoplasty in clefts: an 18-year retrospective review. Facial Plast Surg, 2015, 31(5): 539-552.
10.	石冰.个体化单侧唇裂修复术法与旋转推进法和下三角瓣法设计的比较.华西口腔医学杂志, 2001, 19(1): 28-31.
11.	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): 111-118.
12.	Li Q, Weng R, Gu B, et al. Anchor-shaped nasal framework designed for total nasal reconstruction. J Plast Reconstr Aesthet Surg, 2010, 63(6): 954-962.
13.	蔡生青, 石冰.正常鼻形态的研究进展.国际口腔医学杂志, 2013, 40(3): 378-380.
14.	谢娟, 赵宇, 曹东升.软骨重建在单侧唇裂术后鼻畸形修复中的应用.组织工程与重建外科杂志, 2014, 10(3): 161-163.
15.	Emsen IM. Three-dimensional cartilage graft technique: a different management for nasal tip surgery. J Craniofac Surg, 2016, 27(1): e23-26.
16.	马恬, 韩岩, 张辉, 等.自体材料在鼻畸形修复中的个性化应用.山西医科大学学报, 2016, 47(4): 393-395.
17.	廖俊琳, 周建大.自体颗粒软骨在鼻整形应用中的研究进展.中国美容医学, 2015, 24(15): 78-81.
18.	朱志超, 万林忠, 许波, 等.自体颗粒状肋软骨移植的实验研究.口腔医学, 2014, 34(7): 520-523.

1. 王苗苗, 李毅.唇裂鼻畸形的研究现状.组织工程与重建外科杂志, 2009, 5(4): 235-237.
2. Gassling V, Koos B, Birkenfeld F, et al. Secondary cleft nose rhinoplasty: Subjective and objective outcome evaluation. J Craniomaxillofac Surg, 2015, 43(9): 1855-1862.
3. Lonic D, Morris DE, Lo LJ. Primary overcorrection of the unilateral cleft nasal deformity: quantifying the results. Ann Plast Surg, 2016. [Epub ahead of print].
4. 张莉, 程新德, 朱云琳, 等.单侧唇裂继发鼻畸形的临床修复体会.中国美容医学, 2015, 24(3): 19-22.
5. Masuoka H, Kawai K, Morimoto N, et al. Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities. J Plast Reconstr Aesthet Surg, 2012, 65(7): 857-863.
6. Lünenbürger H, Roknic N, Klein M, et al. Treatment outcome of the transfacial titanium epiplating system for total nasal defects. Plast Reconstr Surg, 2016, 137(2): 405e-413e.
7. 肖文芝, 刘华, 陈涌, 等.单侧唇裂继发鼻畸形的临床整复.中国美容医学, 2014, 23(3): 183-186.
8. Wolfe SA, Nathan NR, MacArthur IR. The cleft lip nose: primary and secondary treatment. Clin Plast Surg, 2016, 43(1): 213-221.
9. Farouk A. Rhinoplasty in clefts: an 18-year retrospective review. Facial Plast Surg, 2015, 31(5): 539-552.
10. 石冰.个体化单侧唇裂修复术法与旋转推进法和下三角瓣法设计的比较.华西口腔医学杂志, 2001, 19(1): 28-31.
11. 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): 111-118.
12. Li Q, Weng R, Gu B, et al. Anchor-shaped nasal framework designed for total nasal reconstruction. J Plast Reconstr Aesthet Surg, 2010, 63(6): 954-962.
13. 蔡生青, 石冰.正常鼻形态的研究进展.国际口腔医学杂志, 2013, 40(3): 378-380.
14. 谢娟, 赵宇, 曹东升.软骨重建在单侧唇裂术后鼻畸形修复中的应用.组织工程与重建外科杂志, 2014, 10(3): 161-163.
15. Emsen IM. Three-dimensional cartilage graft technique: a different management for nasal tip surgery. J Craniofac Surg, 2016, 27(1): e23-26.
16. 马恬, 韩岩, 张辉, 等.自体材料在鼻畸形修复中的个性化应用.山西医科大学学报, 2016, 47(4): 393-395.
17. 廖俊琳, 周建大.自体颗粒软骨在鼻整形应用中的研究进展.中国美容医学, 2015, 24(15): 78-81.
18. 朱志超, 万林忠, 许波, 等.自体颗粒状肋软骨移植的实验研究.口腔医学, 2014, 34(7): 520-523.

Chinese Journal of Reparative and Reconstructive Surgery

Individualized surgical management of secondary rhinoplasty for cleft lip

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