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Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique.
J Oral Maxillofac Surg. 2016 Jul; 74(7):1465.e1-1465.e21.JO

Abstract

PURPOSE

A surgical strategy for definitive cleft lip-nasal correction that stably provides symmetric and natural nasal forms has not been established to date. The purpose of this study was to describe our surgical techniques and 3-dimensional (3D) assessment results after the definitive correction of cleft lip-nose deformity using an extended spreader cartilage graft with a cross-lap joint technique to achieve a rigid strut for lower lateral cartilage repositioning to obtain a desirable nasal tip projection.

PATIENTS AND METHODS

This study enrolled 14 patients with unilateral cleft lip (UCL) with or without cleft palate and 8 patients with bilateral cleft lip (BCL) with or without cleft palate who underwent definitive nose correction and were followed for 1 to 3 years. All patients were treated by open rhinoplasty, repositioning of the lower lateral cartilage, use of an extended spreader cartilage graft with a cross-lap joint technique for nasal tip support, and medial-upward advancement of nasolabial components with vestibular expansion by a free mucosal graft. For the BCL nose, pedicle flaps from rim skin were used for columella lengthening. Preoperative and postoperative nasal forms were 3-dimensionally analyzed by use of 3D images serially obtained in 12 patients.

RESULTS

The postoperative nasal forms were satisfactorily improved in all patients, without any serious postoperative complications. Preoperative and postoperative 3D analyses showed a significantly projected nasal tip in the postoperative noses of patients in both the UCL group and the BCL group (P < .01 and P < .05, respectively) and a sharper nasal tip angle in the BCL group (P < .05). Lateral deviation of the nasal tip was significantly improved in the center of the face in patients in the UCL group (P < .01).

CONCLUSIONS

The results of this study suggest that the extended spreader cartilage graft using the cross-lap joint graft technique is useful to provide a desirable projection of the nasal tip in the center of the face on definitive correction of both UCL and BCL nose deformities.

Authors+Show Affiliations

Professor and Chief, Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. Electronic address: nakamura@dent.kagoshima-u.ac.jp.Associate Researcher, Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.Resident, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan.Postgraduate Student, Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.Associate Researcher, Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.Research Fellow, Japan Society for the Promotion of Science, Tokyo, Japan; Visiting Researcher, Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27113318

Citation

Nakamura, Norifumi, et al. "Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique." Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, vol. 74, no. 7, 2016, pp. 1465.e1-1465.e21.
Nakamura N, Okawachi T, Matsumoto K, et al. Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique. J Oral Maxillofac Surg. 2016;74(7):1465.e1-1465.e21.
Nakamura, N., Okawachi, T., Matsumoto, K., Kimura, N., Kibe, T., & Fuchigami, T. (2016). Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 74(7), e1-e21. https://doi.org/10.1016/j.joms.2016.03.027
Nakamura N, et al. Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique. J Oral Maxillofac Surg. 2016;74(7):1465.e1-1465.e21. PubMed PMID: 27113318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and 3-Dimensional Analyses of Nasal Forms After Secondary Correction of Cleft Lip-Nose Deformities Using Extended Spreader Cartilage Graft With a Cross-Lap Joint Technique. AU - Nakamura,Norifumi, AU - Okawachi,Takako, AU - Matsumoto,Kouzou, AU - Kimura,Namiko, AU - Kibe,Toshiro, AU - Fuchigami,Takao, Y1 - 2016/03/30/ PY - 2015/12/06/received PY - 2016/03/07/revised PY - 2016/03/18/accepted PY - 2016/4/27/entrez PY - 2016/4/27/pubmed PY - 2017/4/21/medline SP - 1465.e1 EP - 1465.e21 JF - Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons JO - J. Oral Maxillofac. Surg. VL - 74 IS - 7 N2 - PURPOSE: A surgical strategy for definitive cleft lip-nasal correction that stably provides symmetric and natural nasal forms has not been established to date. The purpose of this study was to describe our surgical techniques and 3-dimensional (3D) assessment results after the definitive correction of cleft lip-nose deformity using an extended spreader cartilage graft with a cross-lap joint technique to achieve a rigid strut for lower lateral cartilage repositioning to obtain a desirable nasal tip projection. PATIENTS AND METHODS: This study enrolled 14 patients with unilateral cleft lip (UCL) with or without cleft palate and 8 patients with bilateral cleft lip (BCL) with or without cleft palate who underwent definitive nose correction and were followed for 1 to 3 years. All patients were treated by open rhinoplasty, repositioning of the lower lateral cartilage, use of an extended spreader cartilage graft with a cross-lap joint technique for nasal tip support, and medial-upward advancement of nasolabial components with vestibular expansion by a free mucosal graft. For the BCL nose, pedicle flaps from rim skin were used for columella lengthening. Preoperative and postoperative nasal forms were 3-dimensionally analyzed by use of 3D images serially obtained in 12 patients. RESULTS: The postoperative nasal forms were satisfactorily improved in all patients, without any serious postoperative complications. Preoperative and postoperative 3D analyses showed a significantly projected nasal tip in the postoperative noses of patients in both the UCL group and the BCL group (P < .01 and P < .05, respectively) and a sharper nasal tip angle in the BCL group (P < .05). Lateral deviation of the nasal tip was significantly improved in the center of the face in patients in the UCL group (P < .01). CONCLUSIONS: The results of this study suggest that the extended spreader cartilage graft using the cross-lap joint graft technique is useful to provide a desirable projection of the nasal tip in the center of the face on definitive correction of both UCL and BCL nose deformities. SN - 1531-5053 UR - https://www.unboundmedicine.com/medline/citation/27113318/Clinical_and_3_Dimensional_Analyses_of_Nasal_Forms_After_Secondary_Correction_of_Cleft_Lip_Nose_Deformities_Using_Extended_Spreader_Cartilage_Graft_With_a_Cross_Lap_Joint_Technique_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(16)00362-1 DB - PRIME DP - Unbound Medicine ER -