背景:唇裂鼻畸形(CLND)相关的鼻气道阻塞(CL-NAO)的特征可能不充分,其功能影响后来被低估和被忽视。本系统综述的目的是(1)总结CL-NAO中可用的评估结果,(2)评估当前评估工具的可靠性,(3)确定未来研究的持续差距和不一致之处。
方法:对MEDLINE的系统搜索,EMBASE,和Scopus数据库用于研究CL-NAO的文章。重点关注非裂人群或手术技术的文章被排除在外。提取的数据包括有关研究设计的信息,患者人口统计学,病史,和评估分数。
结果:26篇文章符合入选标准。评估包括患者报告的结果测量(PROMs),CLND的解剖特征,以及鼻腔气流和阻力研究。在CLND中,客观评估通常比主观评估更可靠。文献中单侧CLND比双侧CLND表现得更好。对于单边CLND,裂隙侧比非裂隙侧更受阻,具有前鼻畸形的定型模式,但中,后畸形模式不同。总的来说,关于CLND队列按年龄分层的研究设计存在相当大的异质性,裂隙表型和侧向性,和手术史。
结论:使用了广泛的主观和客观评估工具来表征CL-NAO,包括PROMs,解剖测量,以及气流和阻力指标。总的来说,CL-NAO的客观评估比主观调查更可靠,这可能是由于对CLND人群鼻腔通畅性的不同预期以及研究设计中的巨大异质性所致。
BACKGROUND: Cleft lip nasal deformity (CLND)-associated nasal airway obstruction (CL-NAO) may be inadequately characterized, with its functional implications subsequently underappreciated and neglected. The purpose of this systematic
review is to (1) summarize the available assessment results in CL-NAO, (2) evaluate the reliability of current assessment tools, and (3) identify ongoing gaps and inconsistencies for future study.
METHODS: A systematic search of the MEDLINE, EMBASE, and Scopus databases was performed for articles studying CL-NAO. Articles focusing on noncleft populations or surgical techniques were excluded. Extracted data included information about study design, patient demographics, medical history, and assessment scores.
RESULTS: Twenty-six articles met criteria for inclusion. Assessments included patient-reported outcome measures (PROMs), anatomic characterizations of CLND, and nasal airflow and resistance studies. Objective assessments were generally more reliable than subjective assessments in CLND. Unilateral CLND was better represented in the literature than bilateral CLND. For unilateral CLND, the cleft side was more obstructed than the noncleft side, with stereotyped patterns of anterior nasal deformity but varied middle and posterior deformity patterns. Overall, there was considerable heterogeneity in study design regarding stratification of CLND cohorts by age, cleft phenotype and laterality, and surgical history.
CONCLUSIONS: A wide range of subjective and objective assessment tools were used to characterize CL-NAO, including PROMs, anatomic measurements, and airflow and resistance metrics. Overall, objective assessments of CL-NAO were more reliable than subjective surveys, which may have resulted from variable expectations regarding nasal patency in the CLND population combined with large heterogeneity in study design.