Author(s): Dr. Farkhandah Muhammad Iqbal, Prof. Mirza Shehab Afzal Beg, Dr. Iqra Khan
Received: 19/04/2022 | Revised: 19/01/2023 | Published: 24/02/2023 | Pages: 8-12 |
ABSTRACT
Background:Secondary cleft lip Rhinoplasty is a difficult surgery to perform due to its abnormal anatomical features. There is an anomalous insertion of orbicularis oris in alar base on cleft side along with maxillary deficiency. The collapsed lateral crura and malar region needs structural support for better symmetry. The maxillary augmentation can be done via autogenous iliac bone graft, costal cartilage graft, dermal fat graft and alloplastic materials.The objective of the study is to compare the outcome of dermal fat graft with bone graft for maxillary augmentation.
Methodology:This was a retrospective study done at Liaqat national hospital , Karachi. All patients who presented to outpatient department for cleft rhinoplasty between July, 2015 to December, 2020 were included. Outcome was assessed using visual analog score by surgeon, patient and an independent assessor, after all patient had completed 6-month follow-up. Data analysis was done with SPSS version 21.
Result:38 patients were included in the study. 20 had maxillary augmentation with dermal fat graft. 18 had bone graft. Mean Visual Analogue Score for iliac bone graft was 7.5 whereas for dermal fat graft it was 8.3.
Conclusion:Patients who had maxillary augmentation with dermal fat graft showed better results on visual analogue score as compared to patients who had augmentation with iliac bone graft.
Keywords:Maxillary augmentation, Cleft rhinoplasty, Dermal fat graft, Bone graft
1. Cuzalina, Angelo, and Calvin Jung. “Rhinoplasty for the cleft lip and palate patient.” Oral and Maxillofacial Surgery Clinics 28, no. 2 (2016): 189-202. 2. Nolst Trenité, Gilbert J., Richard HL Paping, and Albert H. Trenning. “Rhinoplasty in the cleft lip patient.” The Cleft palate-craniofacial journal 34, no. 1 (1997): 63-68. 3. Madorsky, Simon J., and Tom D. Wang. “Unilateral cleft rhinoplasty: a review.” Otolaryngologic Clinics of North America 32, no. 4 (1999): 669-682. 4. Moore, Meredith L. Grogan, Thu-Hoai C. Nguyen, Kristopher M. Day, and Adam B. Weinfeld. “Pyriform Costal Cartilage Graft Improves Cleft-Side Alar Asymmetry in Secondary Cleft Rhinoplasty.” The Cleft Palate-Craniofacial Journal 57, no. 5 (2020): 537-542. 5. Talaat, Wael M., Mohamed M. Ghoneim, Yasser M. El-Shikh, Sherif I. Elkashty, Mohammed AG Ismail, and Tarek FA Keshk. “Anthropometric analysis of secondary cleft lip rhinoplasty using costal cartilage graft.” Journal of Craniofacial Surgery 30, no. 8 (2019): 2464-2468. 6. Kim, Yong Bae, Seung Min Nam, Eun Soo Park, Chang Yong Choi, Moon Seok Kang, and Han Gyu Cha. “The Effects of Alar Base Augmentation in Secondary Unilateral Cleft Lip Nasal Deformity.” Journal of Craniofacial Surgery 32, no. 2 (2021): 525-529. 7. Cunha, Giovanni, Audrey Foster Lefort Rocha, Valfrido Antônio Pereira Filho, Mario Francisco Real Gabrielli, and Marisa Aparecida Cabrini Gabrielli. “Atrophic maxilla reconstruction with autogenous iliac graft and guided dental implants.” Journal of Craniofacial Surgery 29, no. 8 (2018): 2218-2219. 8. Kim, Jae Hoon, Jin Woo Song, Sung Wan Park, Won Suk Oh, and Joo Heon Lee. “10th rib cartilage: another option of the costal cartilage graft for rhinoplasty.” Archives of Aesthetic Plastic Surgery 21, no. 2 (2015): 47-53. 9. Tetè, Stefano, Raffaele Vinci, Susi Zara, Vincenzo Zizzari, Alessandro De Carlo, Giorgio Falco, Domenico Tripodi, Amelia Cataldi, Carmen Mortellaro, and Enrico Gherlone. “Long-term evaluation of maxillary reconstruction by iliac bone graft.” Journal of Craniofacial Surgery 22, no. 5 (2011): 1702-1707. 10. Erdogan, Bulent, Asuman Tuncel, Gokhan Adanali, Orgun Deren, and Meltem Ayhan. “Augmentation rhinoplasty with dermal graft and review of the literature.” Plastic and reconstructive surgery 111, no. 6 (2003): 2060-2068. 11. Mommaerts, Maurice Y., Frank Lippens, Johan VS Abeloos, and Lucas F. Neyt. “Nasal profile changes after maxillary impaction and advancement surgery.” Journal of oral and maxillofacial surgery 58, no. 5 (2000): 470-475. 12. Pessa, Joel E., Lisa D. Desvigne, and Vikram P. Zadoo. “The effect of skeletal remodeling on the nasal profile: considerations for rhinoplasty in the older patient.” Aesthetic plastic surgery 23, no. 4 (1999): 239-242. 13. Zemann, W., G. Santler, and H. Kärcher. “Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3D-COSMOS measuring system.” Journal of Cranio-Maxillofacial Surgery 30, no. 3 (2002): 148-152. 14. Fisher, David M., Lun-Jou Lo, Yu-Ray Chen, and M. S. Noordhoff. “Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate.” Plastic and reconstructive surgery 103, no. 7 (1999): 1826-1834. 15. Davis, Richard E., Robert A. Guida, and Ted A. Cook. “Autologous free dermal fat graft: reconstruction of facial contour defects.” Archives of Otolaryngology–Head & Neck Surgery 121, no. 1 (1995): 95-100. 16. Little, J. William. “Applications of the classic dermal fat graft in primary and secondary facial rejuvenation.” Plastic and reconstructive surgery 109, no. 2 (2002): 788-804. 17. Issa, Sabah Abdul-Aziz, and Mustafa Emaduldeen Jameel. “Free Dermal Fat Graft for Reconstruction of Soft Tissue Defects in the Maxillofacial Region.” Craniomaxillofacial Trauma & Reconstruction 13, no. 4 (2020): 260-266. 18. Nakakita, Nobuaki, Kouichirou Sezaki, Yasuharu Yamazaki, and Eiju Uchinuma. “Augmentation rhinoplasty using an L-shaped auricular cartilage framework combined with dermal fat graft for cleft lip nose.” Aesthetic plastic surgery 23, no. 2 (1999): 107-112. 19. Fagrell, Dan, Sverker Eneström, Anders Berggren, and Barbara Kniola. “Fat cylinder transplantation: an experimental comparative study of three different kinds of fat transplants.” Plastic and reconstructive surgery 98, no. 1 (1996): 90-6. 20. Choi, Min Hyub, Wei Jie He, Kyung Min Son, Woo Young Choi, and Ji Seon Cheon. “The efficacy of dermofat grafts from the groin for correction of acquired facial deformities.” Archives of Craniofacial Surgery 21, no. 2 (2020): 92. 21. Kim, Gi-Jung, Young-Soo Jung, Hyung-Sik Park, and Eui-Wung Lee. “Long-term results of vertical height augmentation genioplasty using autogenous iliac bone graft.” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 100, no. 3 (2005): e51-e57. 22. Romano, James J., Nicholas T. Iliff, and Paul N. Manson. “Use of Medpor porous polyethylene implants in 140 patients with facial fractures.” The Journal of Craniofacial Surgery 4, no. 3 (1993): 142-147. 23. Sabuncuoglu, Fidan, Altan Varol, Metin Şençimen, and Hüseyin Ölmez. “Onlay iliac bone grafting as an ancillary augmentation procedure for paranasal rejuvenation during bimaxillary surgery.” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 109, no. 2 (2010): e13-e19.
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