Short term results of philtrum reconstruction with an orbicularis oris muscle flap in cleft patients

PurposeIn the treatment of philtral ridge deficiency in cleft lip patients, optimal results are difficult to obtain due to visible scarring following surgery. The purpose of this article is to introduce a novel strategy for philtrum reconstruction along with an evaluation of postoperative outcomes of this technique.MethodAll patients with a deficiency of the philtrum underwent reconstruction of the philtral ridge and upper lip using an orbicularis oris muscle flap with a specific re-suturing technique in our study. The convexity of the philtral ridge was evaluated pre- and postoperatively at rest and while puckering using patient photography as well as three-dimensional simulation technology. Postoperative outcomes and complications were assessed during follow-up, including a patient satisfaction survey.ResultsThirty cleft lip patients underwent treatment in this study using a specific orbicularis oris muscle re-suturing technique. The average age of the 13 male and 17 female patients was 31.5 years. The follow-up period ranged from 6 months to 3.5 years with an average of 10.3 months. Postoperative results showed an aesthetic reconstructed philtral ridge with stable outcome. Complications included acute infection (1 case) and temporary stiffness of smile (3 cases). No systemic complications occurred. All patients were satisfied with their results, and none required further surgery.ConclusionWe propose a simple, effective, and reproducible technique involving an orbicularis oris muscle flap for the creation of the philtral column in secondary cleft lip deformity. Our approach allowed aesthetically pleasing and stable outcomes. Although the short-term results of the philtrum reconstruction seem to be adequate there is no information on the long-term situation, and therefore no general recommendation to adopt this method can be given.     

Cleft lip: our experience in repair

Abstract  

The ideally repaired cleft lip should provide a symmetrical cupid’s bow, philtrum and a minimal scar. The lip length, pout and symmetry of the alar base should be maintained to achieve the best result. The most popular method for cleft lip repair is rotation advancement technique introduced by Millard which improves the relationship of alar base of cleft side, produces harmonious symmetry of the nostril, the surgical scar is masked in the philtral crest and nostril floor. In addition, it uses and preserves the lip anatomy, returns lip tissue into its normal position, minimizes amount of tissue discard and reconstructs orbicularis oris muscle.     

单侧隐性唇裂整复方法的研究

目的：探讨单侧隐性唇裂的修复方法及疗效。方法：对25例单侧隐性唇裂患者采用改良唇裂修复术进行手术治疗,C瓣中的肌肉向外旋转与鼻翼基底的口轮匝肌缝合,为了恢复唇弓的对称性,患侧唇峰上方设计三角形皮瓣。结果：25例患者中,伤口均Ⅰ期愈合,术后唇弓和上唇的形态恢复良好,患侧人中嵴较明显,鼻畸形得到明显改善。结论：改良唇裂修复术治疗单侧隐性唇裂可以有效地恢复上唇的对称性和丰满度。     

口轮匝肌功能重建修复单侧完全性唇裂

目的 探讨口轮匝肌功能重建在单侧完全性唇裂修复术中的应用及效果评价。方法 回顾分析2007年—2011年我科收治的82例单侧完全性唇裂患者,其中52例唇裂整复术中同期行口轮匝肌功能重建术,而30例仅行单纯唇裂整复术。2组患者均随访6个月,测量比较2种治疗方法整复后的患者术后鼻唇外形。结果 在唇裂整复术同期应用口轮匝肌功能重建组的患者,术后可获得更好鼻唇对称性,患侧上唇高度及鼻孔高度明显优于未行口轮匝肌重建组（P<0.01）,并可获得满意的人中、鼻堤、红唇形态。结论 单侧完全性唇裂整复术中同期施行口轮匝肌功能重建能有效地恢复口轮匝肌连续性及其生理功能,有助于提高单侧完全性唇裂的治疗效果。     

The effect of botulinum toxin A in unilateral cleft lip scar: comparison of results with different sites of injection

Botulinum toxin type A (BTA) injections into the subjacent orbicularis oris muscle have been shown to improve appearance and produce narrower cheiloplasty scars. This study was performed to determine the effect of BTA injected at different sites on the unilateral cleft lip scar and cleft side nostril width. A double-blind, randomized prospective trial was conducted involving 64 consecutive patients with unilateral cleft lip undergoing primary cheiloplasty between September 2016 and January 2019. The patients were randomized to receive BTA injections either into the subjacent orbicularis oris muscle (4 points group) or into the bilateral nasolabial fold region (6 points group) during cheiloplasty. The scars were assessed by photographic scar width measurements and Vancouver scar scale assessment tool. The cleft side nostril width was compared to the non-cleft side width. Fifty-six patients completed the trial, 24 in the 4 points group and 31 in the 6 points group. There was no significant difference in scar width or nostril width measurements between the groups at the end of follow-up. The Vancouver scar scale assessment was also similar between the groups. There was no significant difference in scar width or nostril width measurements after cleft lip repair between patients treated with botulinum toxin injections to the subjacent orbicularis oris muscle and patients treated with injections in the nasolabial region.     

66例双侧唇裂功能性整复的临床疗效观察

目的 探讨改良Mulliken法功能性修复双侧唇裂的临床效果。方法 选取66例双侧唇裂患者,应用改良Mulliken法进行唇裂整复,术中在前唇设计窄的“领带”型人中结构;解剖复位侧唇口轮匝肌,重建口轮匝肌环;利用侧唇唇红组织重建唇珠。同期初步矫正鼻畸形,延长鼻小柱。结果 术后经0.5~2 a随访,所有患者无“三等份上唇”不良外观,超过80%（54/66）的患者上唇唇弓形态恢复自然,左右对称,人中宽度与正常相似。唇红丰满,唇珠大小适度,无口哨畸形,动静态外形良好。鼻底宽度正常、鼻孔形态对称,鼻小柱高度较术前延长,鼻尖形态基本满意。结论 利用改良Mulliken法功能性修复双侧唇裂,能有效纠正鼻唇畸形,临床效果良好,值得推广使用。     

口轮匝肌肌瓣瓦合法在单侧唇裂一期修复中的应用

目的 探讨单侧唇裂一期修复中应用口轮匝肌肌瓣瓦合法重建人中嵴的疗效。方法 收集我科2013年1月—6月收治的单侧唇裂患儿52例,男41例,女11例;月龄3~72个月,中位月龄5个月,平均7.4个月。于全麻下行一期唇裂修复术（改良Millard Ⅲ式）时,在口轮匝肌功能复位的基础上,行瓦合法缝合患侧人中嵴处口轮匝肌,造成患侧人中嵴处口轮匝肌增厚,形成隆起的人中嵴外观。结果 术后切口均一期愈合,所有患儿随访9~14个月,平均11.4个月;重建人中嵴形态逼真,与健侧人中嵴基本对称,形态满意。结论 单侧唇裂一期修复时,在口轮匝肌功能复位的前提下,行人中嵴处口轮匝肌瓦合法缝合,使人中凹显现,重建人中嵴,可使上唇外形更为逼真、生动,值得临床推广应用。     

单侧不完全唇裂整复的人中再造研究

目的探讨单侧不完全唇裂整复的人中再造研究。方法采用Millard法对41例单侧不完全唇裂患儿进行整复手术。将鼻底部错位肌肉切断,解剖裂隙两侧口轮匝肌5mm,并作患侧肌肉断面1/2处水平剖开3mm,人中正中作纵向1mm深切口,唇红组织两侧作附加切口。通过相应的缝合方法,形成明显的人中结构。术后六个月复诊评估疗效。结果41例整复患儿中,术后人中形态满意28例,较满意6例,满意率为82.9%。结论单侧不完全唇裂整复中,采用Millard手术方法及口轮匝肌功能性修复,再造人中形态是非常有效的。     

唇裂术中口轮匝肌的解剖学修复

目的：探索唇裂患者口轮匝肌解剖学修复的方法。方法：解剖分离患侧口轮匝肌深怪、浅层的鼻唇不及鼻束。深层及浅层鼻唇束与健侧相应仙束缝合。鼻束与位与鼻小柱下方鼻唇束形成的旋转的肌瓣缝合。结果：对10例唇裂患者进行口轮匝肌的解剖学修复，术后切口瘢痕较小。动态及静态上唇形态满意。结论：口轮匝肌的解剖学修复有利于唇裂患者动态及静态的形态修复。     

改良Millard''s功能性修复双侧唇裂

目的 探讨双侧唇裂的功能性修复方法。方法 应用改良Millard‘s法通过增加环鼻翼外侧脚切口，使鼻翼外侧脚更易复位，矫正了口轮匝肌的异常附着，一期重建口轮匝肌环，对于前唇过于短小者则借鉴Barsky‘s法延长前唇。应用该方法修复双侧唇裂24例，年龄最小6月，最大12岁。结果 多数患者获得了满意的修复效果，仅1例伤口部分裂开。结论 应用该方法修复双侧唇裂有较高的临床应用价值。     

功能整复在单侧完全唇裂术后畸形的临床应用

目的研究和探讨单侧完全唇裂术后畸形的整复方法。方法应用口轮匝肌解剖学和功能性整复修复,对单侧完全唇裂术后畸形进行。结果该术式能有效地矫正鼻小柱偏斜、鼻孔扩大、鼻翼外侧脚变钝等畸形,尽可能恢复唇弓形态,减轻鼻部畸形。结论该术式在临床应用上获得了较满意的功能及形态的结果。     

双侧完全性唇裂唇肌功能整复术后的肌电活动研究

目的:利用肌电图仪客观地评价双侧唇裂功能性修复后唇部肌的动态效果。方法:利用肌电图仪,对25例用直线缝合法修复后的双侧完全性唇裂和20例用口轮匝肌成形的肌功能恢复性方法修复后的双侧完全性唇裂患者的上唇部,包括左、右侧唇及前唇进行肌电测定,分别测定每位患者在静息姿势位时和用力最大噘嘴前突位时各部分的最大肌电幅值,并对其进行对比分析。结果:在静息姿势位时,两组患者的前唇、侧唇均无肌电活动;在最大噘嘴位时,口轮匝肌成形的功能性修复组患者的前唇与左、右侧唇之间的肌电幅值无显著差异,而直线修复组患者的前唇肌电幅值则明显小于两侧唇,也明显小于肌功能性修复组患者的前唇肌电幅值。结论:口轮匝肌成形的肌功能恢复性修复方法对完全性双侧唇裂患者唇部运动功能的恢复优于单纯直线缝合法,提示双侧完全性唇裂手术修复时口轮匝肌成形的必要性。     

Reconstruction of bilateral cleft lip and nose deformity

Bilateral cleft lip and nose deformity can be divided into several types according to the extent of the cleft, protruding premaxilla, size of prolabium and nose deformity. Many repair techniques introduced in the literatures were not perfect because of the change of facial profile under the influence of facial growth.The author uses 1-stage cheiloplasty with nose correction for bilateral cleft lip and nose deformity. Early lip adhesion is used before definitive corrections in wide-cleft patients. The lateral mucosal flaps are used for the lining of alveolar cleft. The lateral orbicularis oris peripheralis flaps with the mucosa approximate in front of premaxilla with creation of a buccal alveolar sulcus and continuity of an orbicularis oris muscle. The lateral orbicularis marginalis muscle flaps with white skin roll and vermillion are used for reconstruction of the Cupid's bow. To enhance the median tubercle, prolabial vermilliomucosal flap is inserted into the gap between an approximated orbicularis peripheralis flap and an approximated orbicularis marginalis flap. Z-plasty of the vestibular ridge and the fixation of lower lateral cartilages to dissect through alar rim excision achieve columella lengthening and tip projection. Lip scar revision is rare, but secondary nose correction using triple V-Y flap is frequent.     

Philtrum formation in congenital cleft of upper lip

Philtrum (labial groove) has aesthetic importance and governs individual features of human face. There are discussed the ways of philtrum reconstruction described in domestic and foreign literature. The main principles of the upper lip central part formation in one-sided congenital clefts are set out. Method of orbicularis oris muscle myoplasty by putting in the asymmetric stitches on deep and surface layers lets to reconstruct the philtrum and its column on the cleft side. Such philtrum reconstruction was performed in 90 cases of primary and secondary cheiloplasty in female patients with congenital one-sided clefts of the upper lips. Long-term results of 58 primary and 14 correcting operations on the upper lips were followed in the time period from 1 to 5 years. Good aesthetic results were achieved in 86.21 and 92.86% of the cases, respectively.     

化妆技术用于唇裂术后患者唇畸形修饰的效果探讨

目的 探讨化妆技术用于唇裂术后患者唇畸形修饰的效果。方法 选择35例唇裂术后鼻唇畸形需行唇裂二期修复手术的患者,术前运用化妆技术进行唇部畸形修饰,分别在化妆前和化妆后为患者拍摄正面照片,由患者及医务人员分别观察照片,采用Visual Analogue法（患者）和Asher-McDade、Mortier PB量表（医务人员）对化妆前后的唇部外形进行外观评价,比较化妆前后的改善情况。结果 化妆前,患者的自我评价分数为（56±13）分,医务人员的评价分数为（3.22±1.11）分,化妆后患者评分为（67±12）分,医务人员评分为（2.85±1.03）分,化妆前后的差异均有统计学意义（P<0.05）。结论 合理有效地运用化妆技术,可以在一定程度上修饰唇裂术后患者唇部的相关畸形。化妆修饰在恢复唇峰对称性、唇弓连续性以及凸显人中嵴等方面具有明显的效果。     

Full-thickness skin graft in the secondary repair of bilateral cleft lip. A case report.

A 13-week-old boy with bilateral complete cleft lip and palate is presented. He had three attempted repairs of his lip elsewhere over a period of four weeks, and all of these broke down. Consequently, a substantial amount of his prolabium became necrotic. After a preoperative orthodontic realignment of the cleft segments, a secondary lip/nose repair was performed. The mucosa was reconstructed by advancement flaps. The orbicularis muscle was dissected out from its abnormal insertion and reconstructed in the midline. The philtrum was reconstructed with a full-thickness skin graft from the right postauricular area. The six-month postoperative result was satisfactory. This technique could be considered as an alternative to primary Abbé flap in secondary reconstruction of the cleft lip, although long-term follow-up must be obtained.     

Recovering the personal identity of an elderly patient with cleft lip: a case report

Instances of unoperated cleft lip and/or palate (CLP) in adult or elderly patients are still seen in developing countries. This paper presents the multidisciplinary management and the personal identity revival of a 72‐year‐old patient with unoperated unilateral complete cleft lip. The facial deformity was characterized by a protrusion of the excess of orbicularis oris muscle, irregularities of the upper lip, nose distortion, and septum deviation to the cleft side. The patient was edentulous with the maxillary alveolar ridge collapsed and an associated fistula. The cleft lip was repaired using the Tennison–Randall technique and complete dentures were delivered after the oroantral fistula had been closed. The patient was very pleased with the improvement in speech and eating and she approved of her facial esthetics. The existence of unoperated oral clefts in the elderly population highlights the need to improve policies in treating patients with CLP, mainly in developing countries.     

Three-dimensional creation of the peak of Cupid’s bow by muscle tension line group reconstruction in secondary cleft lip repair

The peak of Cupid’s bow is a unique three-dimensional structure. Traditional reconstructive techniques focus only on the correction of vermillion border malalignment and the vertical discrepancy between Cupid’s bow peaks from a two-dimensional perspective. The aim of this study was to introduce a novel technique – the muscle tension line group reconstruction technique – to recreate the Cupid’s bow peak three-dimensionally in secondary cleft lip repair. With this technique the orbicularis oris muscle is divided into two flaps: a lateral one composed of pars marginalis and a medial one composed of pars peripheralis. The full thickness of the medial flap is sutured to the deep layer of the lateral flap, and the end of the lateral flap is then sutured to the dermis lateral to the philtral dimple to accentuate a depression. In this way, the two muscle flaps exert opposing skin traction on each side of the peak, which improves the vertical height as well as the lateral projection of the Cupid’s bow peak. The postoperative outcomes indicate that this is a reliable technique for three-dimensional restoration of the Cupid’s bow peak, with a stable and natural reconstructive appearance.     

应用Millard法分期修复双侧先天性唇裂

目的：评价Millard法分期修复双侧先天性唇裂的效果。方法：自2005年—2008年尝试用分期手术治疗双侧先天性唇裂12例。以典型Millard法修补一侧裂隙,将双侧唇裂改变成单侧唇裂,4～6个月后再以同样方法修补另一侧裂隙,完成手术治疗。结果：12例患儿均分两期顺利完成手术,伤口一期愈合。由于完全保留了前唇下方唇红组织,术后能形成自然唇珠形态,同时避免了“方块”形人中,从而使修复后的外形更加美观。对于双侧混合性唇裂,分期手术的效果明显优于一次法。结论：分期修复的方法发挥了Millard法的优势,修复效果良好,尤其适合于治疗双侧混合性唇裂。     

双侧唇裂术后唇鼻畸形的美容整形术

目的 :探讨双侧唇裂继发畸形美容整形术的技术改进。方法 :采用两侧红唇上缘的小三角瓣插入到原人中的下方来延长上唇 ,及利用 2种方案修复鼻畸形。结果 :双侧唇裂术后唇鼻畸形Ⅱ期美容整形术12例均取得了比较明显的手术效果。结论 :此方法在唇峰重建、唇珠再造、人中凹形成及唇鼻畸形的矫正方面有比较独特的效果