单侧完全唇腭裂同期修复的几个问题探讨

目的 探讨单侧完全唇腭裂同期修复方法的问题。方法 使用高频电刀切开腭部粘－骨膜瓣、切断腭腱膜及去队箭腭部翻转瓣粘膜上皮,三瓣法修复腭裂,瓦合瓣法修复鼻前庭裂,化匝肌功能性重建加五瓣法修复唇裂。结果 全部病例均有不输血的情况下一期完成,切口均愈合良好,形态及功能满意。结论 该方法简单、衫和、是单侧完全唇裂同期修复的一种较较好方法。     

TIBIA AS DONOR SITE FOR ALVEOLAR BONE GRAFTING IN PATIENTS WITH CLEFT LIP AND PALATE: LONG TERM EXPERIENCE

Tibial bone grafts were studied in 137 patients with clefts of the lip and palate. Twenty-one had clefts of the lip and primary palate and 116 had complete unilateral clefts of the lip and palate. Bone grafting was performed secondarily or late secondarily. Bone was harvested from the proximal part of the tibia distal to the tuberosity through an incision about 15 mm long. The mean follow-up time after bone grafting was 5.5 years (range 2-11). There were no operative, or early or late postoperative complications reported (such as haematoma, fracture, or shortening of the limb). Harvesting time was about 15 minutes. The possibility of operating with two teams makes the total operating time shorter. Bleeding was negligible (less than 15 ml) and the amount of bone obtained was always sufficient. Patients were mobilised the next day and were back to full physical activity by one month. Indications for tibial bone grafting included facilitation of tooth eruption into the graft, giving bony support to the neighbouring teeth, making it possible to insert a titanium fixture, raising the alar base of the nose, and closing an oronasal fistula. Compared with iliac, cranial, mandibular, and costal donor sites, using the tibia took less time, gave less bleeding, made it possible for two teams to operate simultaneously, gave a smaller scar, and there were minimal complications and satisfactory quantity and quality of bone in all cases. The results suggested that the tibia is an excellent choice of graft for residual alveolar clefts in patients with cleft lip and palate.     

旋转推进、三角组合瓣修复单侧唇裂

为克服Millard法Ⅰ式及Ⅱ式修复单侧完全性裂存在缺点。采用鼻底下旋转推进瓣,唇弓上三角瓣的组合瓣法修复单侧完全性后裂。避免了术后患侧上后偏短及上唇直线疤痕缺陷。患侧唇峰确定在与健侧唇峰口角距等长处,并用健侧唇红肌肉辩插入祢补患侧唇红厚度不足,从而避免术后唇弓不对称畸形。术中充分游离患侧鼻翼外侧脚及鼻翼软骨皮肤面,可明显改善鼻翼畸形。取得满意修复效果。旋转推进辩和三角组合辨是修复单侧完全性唇裂纹理想术式。     

整体旋转复位治疗单侧唇裂继发鼻翼畸形

目的：探讨单侧唇裂继发鼻畸形的手术疗效。方法：通过对鼻翼软骨，鼻翼、鼻孔基底环昨合结构的修复和整体旋转复位治疗单侧唇裂继发鼻畸形。结果：自１９９４年１月至１９９９年８月共同此手术治疗３６例，效果满意，其中２３例进行了３个月～２４个月的随访均示见并发症发生。结论：本手术切口相对隐蔽，复位良好，安全可靠，效果满意。     

婴儿期单侧完全性唇腭裂术前正畸治疗的临床研究

目的探讨上颌-鼻软骨整形矫治器在婴儿期单侧完全性唇腭裂术前正畸中的应用与疗效。方法2003年1月~2004年3月,对100例出生后10 d~3个月内单侧完全性唇腭裂婴儿进行上颌-鼻软骨整形矫治器矫治。其中男60例,女40例,健康状况良好。根据矫治起始时间的不同分为观察组(10 d~1个月内)及对照组(1~3个月)各50例,对比两组婴儿正畸治疗前后上唇裂隙、上前牙槽突裂隙关闭程度及唇腭裂联合整复术后3个月鼻翼外观满意度,评价疗效。结果婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度观察组为5.0±1.6 mm、4.1±2.7 mm,6.9±2.6 mm、6.4±2.9 mm;与对照组7.5±3.1 mm、8.3±3.0 mm,12.5±4.0 mm、10.8±2.6 mm比较,差异均有统计学意义(P<0.05)。两组婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度自身比较,差异无统计学意义。两组患儿术后鼻翼外观满意度观察组86.3%与对照组62.4%比较,差异有统计学意义(P<0.05)。结论尽早对单侧完全性唇腭裂患儿实施上颌-鼻软骨整形矫治器矫治,可明显改善上颌形态及鼻畸形程度,减小牙槽突裂隙,并有效减小上唇张力,为婴儿期唇腭裂联合手术创造有利条件。     

对偶三角瓣矫正唇裂术后小鼻孔畸形

本文以鼻翼对偶三角瓣法结合鼻翼软骨悬吊矫治单侧唇裂术后继发小鼻孔畸形16例,取得满意效果。阐述了唇裂术后继发小鼻孔畸形的原因及鼻翼对偶三角瓣修复的手术方法。实践证明这一方法治疗唇裂术后继发小鼻孔畸形具有一定的优越性。     

榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形

目的探讨榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形的疗效。方法 2009年1月-2011年8月,收治43例单侧唇裂修复术后继发人中嵴畸形患者。男23例,女20例;年龄18～31岁,平均23.6岁。左侧26例,右侧17例。唇裂采用MillardⅠ式修复15例,MillardⅡ式修复28例。唇裂修复术至此次手术时间为15～30年,平均21.7年。术中切取双侧口轮匝肌肌瓣,水平分成上、下两层;双侧下层肌瓣相互重叠缝合,上层肌瓣形成榫卯型结构,缝合于皮下。结果术后患者切口均Ⅰ期愈合。40例患者获随访,随访时间6～34个月,平均13.4个月。双侧人中嵴隆起、对称,人中凹形态接近正常,上唇动态效果满意。术后6个月38例明显改善,2例改善不明显。结论榫卯型口轮匝肌肌瓣手术操作简便,修复单侧唇裂术后继发人中嵴畸形能较好恢复解剖结构,术后获得良好上唇外形和功能。     

UNILATERAL SUPERIORLY-BASED NASOLABIAL ISLAND FLAP FOR THE RECONSTRUCTION OF THE PHILTRUM

We present a case of reconstruction of the philtrum with a unilateral superiorly-based nasolabial island flap following a secondary Millard's bilateral cheiloplasty in a 23-year-old man with cleft lip and palate. His philtrum consisted of a full-thickness skin graft transplanted at one of his previous operations.     

RECONSTRUCTION OF ORBICULARIS ORIS AND LEVATOR LABII SUPERIORIS MUSCLES IN SECONDARY REPAIR OF UNILATERAL CLEFT LIP

We devised a new method to repair the depression of the nasal floor and inferolateral displacement of the alar base and to reconstruct the philtrum in the secondary repair of unilateral cleft lip. Depression of the nasal floor and inferolateral displacement of the alar base were corrected by advancing a lump of the levator labii superioris, the levator labii superioris alaeque nasi, and the upper part of the superficial orbicularis oris muscles to the anterior nasal spine. When the depression of the nasal floor was too severe to repair using these muscles only, a cranially-based de-epithelialised flap of the scar region on the upper lip was inserted under the nasal floor. The lower, greater part of the superficial orbicularis oris muscle was dissected to the nasolabial fold, brought towards the midline, and laid on the surface of the same muscle on the medial side to be sutured. When the depression of the nasal floor was not severe, the lower, greater part of the superficial orbicularis oris muscle was passed through a tunnel pierced beneath the de-epithelialised scar tissue and sutured to the corresponding components on the medial side to reinforce the philtral ridge. In both cases, if the deep orbicularis oris muscle in the vermilion had been interrupted, it was reconstructed by end-to-end anastomosis. Operative results were evaluated in 76 patients using photographs taken preoperatively and postoperatively. Elevation of the nasal floor and correction of the alar base were achieved in most patients, while reconstruction of the philtrum was achieved in cases in which the skin tension at the suture line was weak.     

Millard法加改良下三角瓣法修整唇裂术后畸形

目的：探讨对鼻孔过宽、鼻小柱偏斜、患侧唇高度过短及红唇缺少的唇裂术后畸形的修整。方法：用Millard法加改良下三角瓣对7例此类患者唇部畸形进行了修整。结果：Millard法使鼻孔过宽、鼻小柱偏斜畸形得到矫正，患侧唇峰高点下降，附加改良三角瓣设计使唇峰高点得到充足的下降，恢复了患侧唇高。并有效的减少了唇部组织的丢失。结论：利用Millard法加改良下三角瓣修整此类唇裂术后畸形取得了较理想的效果。     

正畸治疗中口唇形态变化的评价

目的 研究在正畸治疗中影响唇形态及位置变化的因素。方法 通过对双颌前突的成年女性正畸治疗前后的Ｘ－线头影测量片的软组织形态的比较分析，寻求影响唇的形态变化的临床因素。结果 上下唇的突度平均减少２．３８ｍｍ和２．２２ｍｍ，鼻唇角的平均变化为９９．５３到１１１．２６度，下下唇长度也平均增加１．３８ｍｍ和４．６０ｍｍ，而唇的厚度则无明显的改变。讨论 唇形态的变化不仅受到前牙移植的影响，而且与年龄、性别和     

旋转推进法在单侧唇裂Ⅱ期整复中的应用

目的：探索单侧唇裂术后继发唇鼻畸形较好的治疗方法。方法：比较近年来治疗此病的各种不同手术方法之效果，重点观察旋转推进法（Mllard法）的疗效。结果：应用旋转推进法获得了是治疗结果，本法尤其适用于上唇有近似直线宽大瘢痕，患唇下降不足及唇红缘明显不齐者。结论：旋转推进法在单侧唇裂Ⅱ期整复中有较广的适应证，同时应注意治疗的整体效果。     

TISSUE ENGINEERING OF HIGH DENSITY POROUS POLYETHYLENE IMPLANT FOR THREE-DIMENSIONAL RECONSTRUCTION: AN EXPERIMENTAL STUDY

Three-dimensional defects have been reconstructed with carved and remodelled frameworks wrapped within vascular carriers. If sufficient vascular penetration can be established without any change in the size and shape of an implant, it will be possible to cover it with a skin graft and aesthetically important fine details can be obtained. To achieve this, we first prefabricated high-density porous polyethylene implant in rabbits. Secondly, we applied full-thickness skin grafts over the anterior surface of the prefabricated implant. The implants were placed and anchored underneath the superficial inferior epigastric artery and vein pedicle bilaterally. A total of 10 implants were prefabricated and then grafted in five rabbits. The implants were evaluated by perfusion scintigraphy and histological examination. Results showed that the implants were invaded by fibroneovascular tissue, and that this tissue, which can be transferred as a pedicled or a free flap, was sufficient to sustain a skin graft.     

单侧唇裂修复术中红唇保留与美容关系的探讨

目的：探讨在单侧唇裂修复术中红唇组织的保留方法与面部美容的关系。方法：通过322例单侧唇裂修复术中对红唇的处理方法进行总结分析。结果：红唇部形态自然、丰满,唇珠完整、微突。结论：在单侧唇裂修复术中,完全保留红唇是可行的,也是增进面部美容的关键所在。     

五瓣法修复单侧唇裂的临床研究

为了解决唇裂修复术后患侧唇高不足和直线瘢痕挛缩问题,自1987年以来,采用五瓣法修复单侧唇裂37例,获得了预期的效果。文中介绍了定点设计及操作过程。并就其优点、适应证及应用注意事项进行讨论。该方法是一种可供选择的术式。     

RECONSTRUCTION OF TOTAL LOSS OF UPPER LIP WITH HAIR-BEARING FLAPS

Carcinoma of the lip is a relatively common problem in Papua New Guinea, accounting for some 12% of all malignant turnours in the oral cavity. The cancer is associated with chewing betelnut with slaked lime and smoking. Advanced squamous cell carcinoma of the upper lip is necessarily managed by primary surgery when radiotherapy facilities are not available. Adequate surgical treatment of these carcinomas usually requires full thickness excision of a portion or whole of the lip. The purpose of this paper is to demonstrate the role of hair-bearing scalp flap for reconstruction of total loss of the upper lip in male patients.     

面斜裂整形修复中泪道重建术的探讨

为了解决面斜裂整形修复中泪道重建的难题，１９８９年３月～１９９５年１月，对４例患者治疗中设计了三种手术方法：泪小管鼻腔吻合术；静脉血管或口腔粘膜移植重建泪道术；改良的泪囊鼻腔吻合术。术后重建的泪道置入导管３～６个月。经术后６个月～１年的观察，面部畸形整复，溢泪消失，红汞试验及泪道检查均通畅，效果满意。认为，应根据泪道畸形程度的不同，选择合适的手术方法，以取得最佳疗效。     

RECONSTRUCTION OF A NATURAL-LOOKING UMBILICUS

Based on the assumption that the umbilicus is a wound that has healed by second intention, we describe a method of reconstruction. The procedure consists of complete resection of the umbilical scar and its reconstruction by a linear incision at the site of the new umbilicus and inversion of the skin hedges, which are sutured to the linea alba leaving a 1 cm space between the skin borders to cause secondary wound healing. This procedure provides a natural-looking umbilicus. It is easy and quick to do, and can be used for reconstruction after abdominoplasty, excision of a naevus, or when the umbilicus has been removed during a previous xiphopubic incision.     

婴幼儿唇腭裂同期修复的手术体会

目的：探讨对婴幼和唇腭裂进行早期同期修复术的必要性。方法：对26例6个月－20个月的婴幼儿单侧或双侧唇腭裂进行唇裂、腭裂同期手术修补，对术后患儿的反应及恢复进行观察。结果：手术全部获得成功，患儿术后恢复佳，不良反应较3岁以上患者轻。结论：在手术技术熟练和条件具备的情况下，对2岁以内的婴幼儿唇腭裂进行同期修补术是可行的，既有利于婴幼儿今后的成长，也使患儿及其家长在经济和精神心理上的损失大为降低。     

毒藜碱诱导形成山羊先天性腭裂模型的实验研究

目的探讨采用毒藜碱肌肉注射形成先天性腭裂山羊模型的方法以及先天性腭裂畸形对山羊面中部发育的影响。方法取40只8～12月龄杂交波尔雌性山羊,体重35～55 kg,以配种日期定为孕0 d,于孕30 d经B超确认怀孕后随机将实验动物分为4组。取30只实验动物按照注射剂量分为实验组1、实验组2、实验组3(n=10),分别于孕31～42 d肌肉注射毒藜碱10、15、20 mg/d;余10只作为对照组不作处理。每组于孕120 d及出生后1个月,各取5只胎羊或小羊行头颅三维CT重建,测量上颌最前磨牙前方的两侧凹陷处间距(PPMM),及以此线为基准测量上颌骨最前点至此线的垂直距离(APMM);完成三维CT重建后行硬腭大体观察,并制备干颅行上颌骨前后向及宽度发育情况观察。结果实验组3母羊注射药物后全部流产;实验组2母羊注射药物后2只流产,余8只维持妊娠。孕120 d取材时,实验组1取出5只胎羊,均无腭裂;实验组2取出5只胎羊,其中3只腭裂,上颌发育不足;对照组取出5只胎羊,均无腭裂。出生后1个月,实验组1有11只小羊娩出,均无腭裂;实验组2有7只小羊娩出,其中5只腭裂,上颌骨明显发育不足,饲养及进食困难;对照组有8只小羊娩出,均无腭裂。硬腭及干颅大体观察见实验组2上颌骨明显发育不足。实验组2的孕120 d胎羊及出生后1个月小羊PPMM及APMM与对照组比较,差异均有统计学意义(P<0.05)。实验组2的5只腭裂小羊存活1～2个月。结论采用孕31～42 d肌肉注射毒藜碱15 mg/d,可以制备先天性山羊腭裂模型,形成的腭裂山羊面型特征基本符合人类腭裂畸形面中部发育特征。