| Objectives:1.According to the existing nasal measurements,establish the anthropometry system which is suitable for the secondary unilateral cleft lip nasal deformity in patients of Han nationality.2.To evaluate the outcomes of the costal cartilage transplantation(including the alar circular graft)in the correction of secondary unilateral cleft lip nasal deformity.3.To evaluate the outcomes of the alar circular graft in the reconstruction of the unilateral nasal defect.4.To explore the safety and effect of tissue-engineered cartilage in nasal reconstruction.Methods:1.From January 2011 to December 2020,50 patients with secondary unilateral cleft lip nasal deformity were selected as the research objects,including 18 males and 32 females.According to the characteristics of secondary cleft lip nasal deformity,the linear measurements,angular measurements,proportional measurements and symmetry index of external nose were selected.Photos of the patients were calibrated and measured by Image J software to analyze and obtain the characteristics of secondary unilateral cleft lip nasal deformity in Han nationality.2.From January 2013 to June 2020,a total of 30 patients with secondary unilateral cleft lip nasal deformity received costal cartilage-based open rhinoplasty.And the alar circular graft was applied to correct the collapse of nasal alar on the cleft side.Retrospective study on medical records,preoperative,postoperative and follow-up photos of the patients were carried out.According to the anthropometry system established in the first part,we analyzed the preoperative and postoperative measurements and evaluated the effect of costal cartilage transplantation rhinoplasty(including the alar circular graft)in augmenting the nasal dorsum and improving the nasal symmetry.3.From January 2015 to December 2019,9 patients with unilateral nasal defect received nasal reconstruction with costal cartilage alar circular graft as the alar stent material.Retrospective study on medical records,preoperative,postoperative and follow-up photos of the patients were carried out and the outcome was evaluated.4.From March 2014 to October 2015,one case of congenital nasal deformity and four cases of acquired severe nasal deformities were admitted.The patient with congenital nasal deformity was a four-year-old boy,and the source of seed cells was nasal septal cartilage.The other four adult patients were three males and one female and they all had multiple nasal subunit defects caused by trauma and the source of seed cells was auricular cartilage.The tissue engineered cartilage framework was constructed in the shape of normal human nasal alar cartilage and L-shaped silicone prosthesis with seed cells from cartilage and PGA-PLA compound biodegradable scaffold.The boy underwent nasal deformity correction and silicone prosthesis implantation in the first stage.The prosthesis was removed and the tissue-engineered cartilage was implanted in the second stage.The other four adult patients all received nasal reconstruction with expanded forehead flaps.These patients underwent 1-4 nasal revisions.The implanted tissue engineered cartilage was observed in the operation and taken from two patients for histological examination.Results:1.In Han patients with secondary unilateral cleft lip nasal deformity,the nasal bridge deviation and columellar axis angle were 3.43±3.95° and 14.46±8.76° respectively.Among the symmetry index of the cleft side and the noncleft,the inner nostril height symmetry index,the inner nostril height-to-width ratio symmetry index,the heminasal width symmetry index,the nostril base width symmetry index and nasal anterior angle symmetry index were larger than others.They can better represent the degree of nasal asymmetry.2.All the incisions healed by first intention and there was no graft exposure and infection.In the harvest of costal cartilage,there was one case of pleural rupture.There was one case of obvious scar hyperplasia of donor-site incision and one case of warping of the nasal dorsum graft.All patients were followed up 6 to 24 months with an average of 15.2 months.The columellar axis angle and nasal tip angle decreased after the operation.The nasofrontal angle and nasalfacial angle increased after the operation.The nostril height symmetry index,the inner nostril height-to-width ratio symmetry index,the heminasal width symmetry index,the nostril base width symmetry index,and the nasal alar length symmetry index were significantly reduced,and the nasal symmetry was improved.The nasal lateral angle may not be suitable for evaluating the severity of the nasal deformity,but it has some extent effect on evaluating the postoperative effect.Among the patients,11 cases required revision surgery,and the results were satisfactory after revision.The other patients’ nasal profiles were greatly improved,and they were satisfied with the results of the surgery.3.All the incisions healed by first intention and there was no graft exposure and infection.All patients were followed up 1 to 3 years with an average of 2.1 years.The appearance of the reconstructed nose was fine after 2-3 times of revision.The reconstructed nostril had a good contour and was symmetric with the other side.All the patients were satisfied with the postoperative effect.4.All the incisions healed by first intention after the tissue engineered cartilage implantation,and the expanded forehead flaps survived.Postoperative low fever occurred in two patients.No complications such as infection,obvious immune rejection response,and tissue-engineered cartilage protrusion or exposure were found in all patients.All patients were followed up 9-74 months(54.8 months on average).During the follow-up,the patients had no obvious discomfort in the nose and the ventilation function were good.All patients were satisfied with the nasal contour.Early-stage obvious calcification occurred in one patient after the implantation of tissue-engineered cartilage;the other case showed typical cartilage characteristics.Late-stage histological examination in one patient of tissue engineered cartilage showed the characteristics of fibrous connective tissue;and the other showed there was remaining cartilage.Conclusion:1.There was nasal bridge deviation in Han patients with secondary unilateral cleft lip nasal deformity.The data analysis and comparison of the measurement in Han patients indicated that some symmetry index can better represent the degree of nasal asymmetry.The anthropometry system which is suitable for the secondary unilateral cleft lip nasal deformity in patients of Han nationality has been established preliminarily.2.Autologous costal cartilage-based open rhinoplasty with the alar circular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.3.The costal cartilage alar circular graft transplantation can effectively improve the nasal symmetry of patients with unilateral nasal defect.4.The safety of tissue engineered cartilage constructed in vitro for nasal reconstruction is preliminarily confirmed,but the effectiveness still needs further verification. |
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