口唇裂外鼻の治療

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  • 杠 俊介
    信州大学医学部形成再建外科学教室

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  • Treatment of cleft lip nasal deformity
  • コウシンレツガイ ハナ ノ チリョウ

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<p>　Purpose: The nose of patients with cleft lip is deformed, although the extent of the deformity varies with the degree of lip abnormality. This causes esthetic and functional problems, and does not improve if left untreated.</p><p>However, treatment strategies, including how and when to correct the deformity, vary between surgeons/orthodontists. Here, a review of the relevant literature was performed to consider the optimal strategy, current situation, and issues remaining in the treatment of cleft lip nasal deformity.</p><p>　Issues: The anatomical characteristics of cleft lip nasal deformity are asymmetry in unilateral cases, a short columella and hooding of the alar rims in bilateral cases, and deficiency of maxilla development, a flared piriform aperture, a wide nose, and a broad tip in all types of cases. These characteristics result from the bony deformity, cartilaginous deformities composed of the nasal septum and the upper and lower lateral cartilages, deficit of the nasal lining, and abnormal muscles around the external nose.</p><p>　Treatments: Treatment involves both nonsurgical procedures, i.e., maxillary orthopedics using various types of orthodontic device, and surgical procedures. Operative treatments may be performed in infanthood at the time of primary lip repair, at preschool age, and in adolescence at the end of growth.</p><p>　Conclusion: The patient can have a nose with a natural shape and patent nasal airway without any growth disturbance if the ideal therapeutic intervention is conducted with appropriate procedures at each time point.</p>

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