Application Of L-shaped Tenon-mortise Structure Integral Stent Of Costal Cartilage In The Correction Of Nasal Deformities Of Unilateral Cleft Lip

ObjectiveTo analyze the clinical effect of L-shaped tenon-mortise structure integral stent of costal cartilage in the correction of nasal deformities of unilateral cleft lip.MethodsFrom September 2018 to December 2019,30 patients with unilateral cleft lip and nasal deformities were selected for the study.According to the different surgical methods chosen by the patients,they were divided into L-shaped integral stent group(n= 14)and traditional splicing stent group(n = 16).Integral stent group: the costal cartilage was carved into L-shape,and a groove was formed along the center of the long axis of the short arm.The long arm of the whole stent was embedded between the medial feet of the lower lateral cartilage,and the short arm rode over the middle tail of the nasal septum cartilage to form a tenon-like connection with the nasal septum cartilage.Splicing stent group: two pieces of costal cartilage were fixed on both sides of nasal septum cartilage respectively as nasal septum extension graft(SEG).Another piece was fixed between the medial crus of lower lateral cartilage and used as a nasal columella support graft(STRUT),for splicing and suturing.The operation time of each group was recorded.The patients were followed up at 1 week,6 months and 12 months after operation.The photos of each period before and after operation were objectively evaluated by vernier caliper and photo measurement of Image J software.The differences between each group before and after operation were statistically analyzed by SPSS 26.0 software,and the satisfaction of patients and third parties and complications such as hematoma,scar,cartilage absorption and appearance were investigated.ResultsThe objective measurement data were as follows:(1)Integral stent group:(1)One week after operation,there were significant differences in all measurement items compared with those before operation(P < 0.05).(2)The differences were statistically significant in all measurement items at 6 months after operation compared with those at1 week after operation(P < 0.05).(3)There was no significant difference in all measurement items except the height of nasal tip at 12 months after operation(P <0.05).The results showed that the short-term effect of the patients treated with integral stent method was obvious,such as elevation of nasal tip,prolongation of nasal columella,increase of nasal symmetry,slow deformation and rebound of nose within half a year after operation,while the shape of nose remained stable half a year after operation.However,the height of nasal tip still has a slow downward trend.(2)Spliced stent group:(1)The measured values at 1 week after operation were significantly different from those before operation(P < 0.05).(2)There were significant differences in nasal columella length,nasal alar base asymmetry angle and nasolabial angle at 6months after operation(P < 0.05).(3)The differences were not statistically significant in nasal columella length parameters,nasal alar base asymmetry angle and nasolabial angle at 12 months after operation(P < 0.05).There were still significant differences in nasal tip height,nasal tip deviation parameters and nasal dorsal deviation angle 6months after operation(P > 0.05).The master thesis showed that the nasal shape of the patients corrected by traditional splicing stent method was improved to a great extent,but the nose had a slow deformation and rebound trend within 1 year after operation,and the nasal tip height still had a slow downward trend.The operation time in the integral stent group(2.37 ±0.23)hours was shorter than that in the splicing stent group(2.71 ±0.28)hours,and the difference was statistically significant(P < 0.05).At 12 months after operation,the satisfaction rate of the integral stent group was85.71%,and that of the splicing stent group was 81.25%.The difference was not statistically significant between the two groups(P > 0.05).The satisfaction rate of the third party in the integral stent group was 92.86%,and that in the splicing stent group was 87.5%.The difference was not statistically significant(P > 0.05).The results show that the two surgical methods have exact surgical effect and high satisfaction.No postoperative complications such as hematoma,incision infection,stent collapse and recurrence,obvious scar hyperplasia,suture exposure,graft cartilage exposure and cartilage appearance were found in the two groups.ConclusionThe integral support method of L-shaped tenon-mortise structure of costal cartilage is as effective as the traditional splicing support method for the correction of secondary nasal deformities of unilateral cleft lip.Moreover,compared with the traditional splicing stent method,the costal cartilage integral stent method has the advantages of simple operation,simplified operation process,less time-consuming operation and more stable long-term effect after operation.It is an effective method to correct the secondary nasal deformities of unilateral cleft lip and is worth popularizing in clinic.