Millard法修复单侧唇裂患儿手术前后面部形态的三维分析

目的 利用可见光三维扫描仪分析评价Millard法修复单侧唇裂的效果.方法 随机收集第四军医大学口腔医院2009年5至6月收治的单侧唇裂患儿的I临床资料,共19例,均为一期修复,其中Ⅱ度唇裂7例,Ⅲ度12例.利用3DSS扫描获得患儿手术前、后面部形态数据,将其导入逆向工程软件Geomagie Studio 10.0中生成j维数字化模型.在软件中精确测量手术前、后健、患侧鼻小柱长度、鼻底宽度、鼻翼长度等数据,对测得数据以SPSS12.0统计软件包进行配对t检验及单样本t检验.结果 无论是Ⅱ度还是Ⅲ度单侧唇裂患儿,其鼻底宽度、鼻基部宽度、鼻翼长度、唇长术前、后的差异均有统计学意义(P<0.05,P<0.01).Ⅱ度唇裂患儿术后鼻小柱高度、鼻翼口角距的非对称率与正常人群非对称卒的差异有统计学意义(P<0.05);m度唇裂患儿术后鼻小柱高度、鼻底宽度、鼻基部宽度、鼻翼门角距、唇长的非对称率与正常人群的非对称率差异有统计学意义(P<0.05,P<0.01).结论 Millard法修复单侧唇裂.患儿术后鼻底封闭,鼻小柱偏斜畸形获得矫治,唇弓形态恢复较好,但患侧唇高均有不同程度地下降不足,健、患侧鼻小柱高度的不对称仍较明显.Ⅲ度唇裂患儿术后患侧鼻底宽度仍比健侧宽.

Three-dimensional analysis of facial structure for unilateral cleft lip patients repaired by Millard' s method

Objective To evaluate the aesthetic effect of Millard's method in patients with unilateral cleft lip by three dimensional sensing system. Methods 19 patients with unilateral cleft lip (class II; 7 cases, class III: 12 cases) were randomly selected. The pre- and postoperative 3-D facial profiles were recorded using a 3DSS scanner. Then 3D geometric models were established by Geomagic Studio 10.0. In the software, columella length, nostril floor width, alar base-subnasale distance, alar length, upper lip height, lateral upper lip height and lip length were measured before and after lip repair respectively. Paired-samples T test and one-sample T test were used for statistical analysis with SPSS 12. 0 software package. Results There were significant differences in the nostril floor width, alar base-subnasale distance, alar length and lip length before and after operation ( P < 0. 05 , P < 0. 01) . The ratio of asymmetry in normal people was no more than 0. 1. There was significant difference in the asymmetry ratio of columella length and lateral upper lip height between postoperative class II patients and normal people ( P < 0. 05 ). There was significant difference in the asymmetry ratio of columella length, nostril floor width, alar base-subnasale distance, lateral upper lip height and lip length between postoperative class III patients and normal people (P < 0. 05 or P < 0. 01 ). Conclusions Millard' s technique is useful for repairing unilateral cleft lip in rebuilding nasal floor, the Cupid' bow and in correction of the columella deviation, except for a relatively insufficient lip height and columella length at the operated side. Besides, the nostril floor width at the operated side in class HI patients is still wider than that at the opposite side .