正常与单侧唇裂口轮匝肌和上唇血管的应用解剖

目的:为婴儿单侧唇裂功能性修复提供解剖学基础。方法:４例正常成人新鲜头颈标本,在下颌下缘面动脉远心端内注入红色乳胶。５例正常婴儿、６例单侧唇(腭)裂婴儿标本,经福尔马林固定,从皮肤面和粘膜面解剖上唇口轮匝肌,在手术显微镜下观察口轮匝肌的形态及血管的分布。结果:口轮匝肌分深浅二层。深层肌肉呈水平方向,起自一侧口角的皮肤和粘膜,走向另一侧口角。浅层由上下两束肌纤维组成。单侧完全性唇裂标本显示患侧深层肌肉在裂隙处中断,止于红唇由厚转薄处。而浅层肌肉不仅中断,其附丽点亦发生错位,造成鼻小柱、鼻翼畸形。健侧深层肌肉在裂隙处中断,浅层肌纤维均附于鼻小柱基部,造成鼻小柱向健侧偏斜。正常上唇动脉起始部和走行都较恒定,本组未见解剖异常。唇裂标本显示,一侧动脉不能与对侧同名动脉吻合成弓,还造成异常走行。结论:对单侧完全性唇裂功能性修复,患侧皮下剥离要达到鼻翼外侧,把扭曲错位的浅层肌组织从鼻翼基部及鼻翼外侧的骨膜上进行分离,并按解剖形态进行复位。

Applied anatomy of orbicularis oris muscle and the vessels of upper lip in normal lip and one-side cleft lip

Objective: To provide anatomical basis for the functional reconstruction of lip in one-side cleft lip of infant. Methods: Facial arteries in the margin of lower jaw were injected with red latex on 4 cases of normal adult head specimens. Five normal infant specimens and six single cleft lip specimens were fixed by formalin, and the orbicularis oris muscles in upper lip of these specimens were dissected from the sides of skin and tnucosae respectively. The shape and vessel distribution of orbicularis oris muscles were observed. Results: Orbicularis oris muscles had deep and superficial layers. The deep kyer ran horizontally from the skin and mucosae of one side of corner of mouth to the other side. The superficial layer consisted of upper and lower muscle fiber. On the complete one - side cleft lip specimens, the deep muscles of the defect side broke in the site of fissure, stop and got thick at the site of red lip while the superficial muscle not only broke but also transposed at its point of attachment, and all these resulted in the deformity of columella nasi and alae nasi; the deep muscles of the normal side broke in the site of fissure while superficial muscle fibrers attached at the base of columella nasi, and all those resulted in columella nasi leaning to normal side. The specimens of cleft lip showed that the artery at one side can t anastomoses with the same artery at the orther side. Conclusion: When the functional repair of complete one - side cleft lip is performed, the skin at the defect side should be peeled to the lateral side of alae nasi and the transposed superficial muscle should be separated from the periosteum of the base and lateral side of alae masi.