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Introduction:
Unfavorable results in unilateral and bilateral cleft lip repair are often easy to spot but not always easy to prevent as to treat. We have tried to deal with the more common problems and explain possible causes and the best possible management options from our experience.Unilateral cleft lip repair:
Unfavorable results immediately after repair involve Dehiscence and Scaring. Delayed blemishes include vermillion notching, a short lip, deficiency in the height of the lateral vermillion on the cleft side, white roll malalignment, oro-vestibular fistula, the cleft lip nose deformity, a narrow nostril and a “high-riding” nostril. We analyze the causes of these blemishes and outline our views regarding the treatment of these.Bilateral cleft lip:
Immediate problems again include dehiscence as also loss of prolabium or premaxilla. Delayed unfavorable results are central vermillion deficiency, a lip that is too tight, bilateral cleft lip nose deformity, problems with the premaxilla and maxillary growth disturbances. Here again we discuss the causation of these problems and our preferred methods of treatment.Conclusion:
We have detailed the significant unfavorable results after unilateral and bilateral cleft lip surgery. The methods of treatment advocated have been layer from our own experience.KEY WORDS: Cleft lip nose, contractures, high riding nostrils, scarring, unfavourable results, vermillion deficiency 相似文献2.
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Sykes JM 《Facial Plastic Surgery Clinics of North America》2001,9(1):37-50
Repair of the unilateral cleft lip deformity is a challenging and rewarding procedure. Historically, many techniques have been described to reconstruct the unilateral cleft lip. These have included straight-line repairs and various geometric flap closures. The rotation-advancement flap technique of Millard is a reliable and versatile method for repair of the unilateral cleft lip deformity. This technique allows lip repair and tip rhinoplasty while camouflaging the scars in the newly formed philtral border. If properly applied, the rotation-advancement repair produces excellent functional and aesthetic results (Figs. 18A and 18B). 相似文献
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A congenital cleft lip is a deformity that has significant physical and psychologic impact. Many surgical repairs have been proposed for reconstruction of unilateral cleft lip deformities, including straight-line repairs and various forms of geometric flap repair. This article classifies cleft deformities and describes the history and specific techniques of unilateral cleft lip repair. Understanding and application of these techniques can aid the cleft surgeon in maximizing function and appearance of a child born with a cleft lip deformity. 相似文献
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Percy Rossell-Perry 《Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi》2008,42(3):113-121
We present a new technique for repair of unilateral cleft lip used in 230 patients. This is a modification of Reichert's technique for unilateral cleft lip repair. It is based in three concepts: form, severity, and natural landmarks of the lip. All the incisions are placed on natural landmarks, between the aesthetic subunits of the upper lip. The incision for rotation of the philtrum is designed to imitate the column of the philtrum on the normal side with good aesthetic result. We do not use a subnasal incision on the lateral side. Since 1996, we have used this technique in 230 unilateral cleft lip repairs. We obtained a good functional and aesthetic result in the nose and upper lip. Our failure rate was 14%. We describe Reichert's modified technique, named the Reichert-Millard's technique, with good aesthetic results (fewer scars and more individual designs than traditional techniques) for repair of the lip and nose in patients with unilateral cleft lip. 相似文献
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目的 应用改进的鼻底三角瓣法修复单侧不完全性唇裂 ,以获得更加良好的上唇外形。方法 对单侧不完全性唇裂的首次手术 ,于患侧鼻底部设计三角皮瓣转移下降上唇 ,白唇部裂隙切口直线缝合。结果 6 6例患者修复后上唇外形良好 ,双侧上唇高度对称 ,人中形状完整。结论 鼻底三角瓣法适用于单侧不完全性唇裂的修复 相似文献
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Percy Rossell-Perry 《Journal of plastic surgery and hand surgery》2013,47(3):113-121
We present a new technique for repair of unilateral cleft lip used in 230 patients. This is a modification of Reichert's technique for unilateral cleft lip repair. It is based in three concepts: form, severity, and natural landmarks of the lip. All the incisions are placed on natural landmarks, between the aesthetic subunits of the upper lip. The incision for rotation of the philtrum is designed to imitate the column of the philtrum on the normal side with good aesthetic result. We do not use a subnasal incision on the lateral side. Since 1996, we have used this technique in 230 unilateral cleft lip repairs. We obtained a good functional and aesthetic result in the nose and upper lip. Our failure rate was 14%. We describe Reichert's modified technique, named the Reichert-Millard's technique, with good aesthetic results (fewer scars and more individual designs than traditional techniques) for repair of the lip and nose in patients with unilateral cleft lip. 相似文献
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目的 探讨单侧唇裂继发畸形与I期手术方式选择的关系,以及进行唇裂继发畸形美学修复的策略.方法 选择单侧继发唇裂120例,根据I期采用的不同术式进行分组,对唇裂畸形进行观察和分析,采用个体化设计,进行美学修复.对采用Millard、Tennison、矩形瓣及上三角瓣法的单侧唇裂继发畸形修复后,观察上唇人中窝形念、瘢痕、唇峰形态的恢复.结果 显示原采用Millard方法、上三角瓣方法优于Tennison方法和矩形瓣方法.Ⅱ期修复术后效果满意.结论 单侧唇裂I期采用的手术方式对继发畸形的程度和修复有显著影响. 相似文献
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双侧唇裂畸形多较复杂,修复术后常出现上唇过紧,唇红过薄等继发畸形。为矫正畸形,设计了在直线修复术的基础上增设鼻唇沟瓣及两个小三角瓣的手术方法,取得了较满意的临床效果。认为本方法可恢复前唇的正常功能,有利鼻的发育。 相似文献
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目的 探讨根据口鼻轮廓线设计单侧唇裂Ⅱ期修复手术的方法及临床效果.方法 通过对鼻唇弯曲轮廓的细微研究,从解剖、力学分析入手,结合唇裂畸形的特点,逐步形成以口鼻弯曲轮廓线为手术切口的术式,参考水平线和正中垂直线及外形,对单侧唇裂患者进行Ⅱ期综合整体修复术.结果 该手术方法应用于临床效果医患双方满意.结论 根据口鼻轮廓线设计单侧唇裂Ⅱ期修复术,能取得良好的畸形修复和外形美观效果. 相似文献
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Rajesh S Powar Sandeep M Patil Mark E Kleinman 《Journal of plastic, reconstructive & aesthetic surgery》2007,60(4):422-425
In unilateral cleft lip, there is always a deficiency of vermilion on the medial side of the cleft, which can be augmented by techniques using excess vermilion from the lateral side of the cleft, like the use of a simple V-advancement flap. We developed a modification of Noordhoff's lateral vermilion flap that preserves the parallel relationship of the muco-vermilion line and the white roll but improves results in unilateral cleft lip patients. In a study of 30 patients undergoing surgical repair of complete unilateral cleft lip, we found that this method offers a superior alternative to the straight-line repair. This geometrically sound technique for vermilion reconstruction offers the cleft surgeon a simple and effective method for augmenting total lip height and creating a normal appearing Cupid's bow. 相似文献
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婴幼儿先天性唇裂早期修复同期行鼻畸形矫正初步报告 总被引:2,自引:0,他引:2
目的 探讨婴幼儿先天性唇裂早期修复,同期矫正鼻畸形,以避免唇裂术后继发鼻畸形而再次手术的可行性。方法,采用Millard I式或II式唇裂修复法修复唇裂,同期矫正鼻畸形,使移位的鼻翼软骨,鼻中隔软骨复位,以恢复正常的解剖关系,结果 1998-1999共矫治30例,年龄3个月至3岁,单侧唇裂24例,双侧唇裂6例,随诊最长18个月,效果良好。结论 唇裂患儿幼小时组织比较薄膜,畸形易于矫正,早期修复唇裂,同期矫正鼻畸形,使畸形的鼻翼软骨,鼻中隔恢复到正常的解剖学位置并在此位置 生长发育,鼻畸形可望明显改善。 相似文献
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In cleft surgery, two methods have traditionally been used to mark the height of cupid's bow on the lateral lip element. One technique measures the distance from the oral commissure to the height of cupid's bow on the noncleft side, and transposes this distance onto the cleft-side lateral lip element. The second technique marks the height of cupid's bow on the cleft-side lateral lip element where the white roll disappears. The authors believe these techniques may result in deformities of residual cleft tissue in the repair. Marking the height of cupid's bow on the cleft-side lateral lip element, just before the attenuation of lip fullness, can prevent this deformity. A retrospective study yielded a series of 17 patients with secondary deformities of residual cleft tissue in their repair. The method used to mark the lateral lip element was determined by chart review. Patients then underwent secondary surgery with excision of residual cleft tissue, and repair using the initial technique. A random group of primary cleft patients, repaired using the authors' technique for marking the lateral lip element, was likewise evaluated for the presence of residual cleft tissue in the repair. Of the 17 cases of secondary deformities, 14 were unilateral and 3 were bilateral. Among the unilateral cases, seven were repaired with a triangular flap and seven by rotation advancement. The bilateral cases were repaired using the modified Millard technique. The lateral lip element was marked using cessation of the white roll in 8 patients, and the commissure to the height the of cupid's bow in 2 patients, whereas in 7 patients the method was unreported. Using the authors' technique, both "controls" repaired primarily and cases repaired secondarily resulted in no redundant cleft tissue. Average follow-up was 11 months (range, 1-41 months). The authors think that traditional markings for establishing the height of cupid's bow on the cleft lateral lip element may result in residual cleft tissue in the repair. This deformity can be prevented by marking the height of cupid's bow on the cleft lateral lip element just before the attenuation of lip fullness. 相似文献
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H Friede M M?ller J Lilja C Lauritzen B Johanson 《Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi》1987,21(1):65-71
Cephalometric radiographs and dental study casts were analyzed in a group of 23 seven-year-old cleft lip and palate patients, 16 with unilateral and 7 with bilateral cleft. The patients' primary surgical procedures had been completed except for closure of the cleft in the hard palate. For comparison, similar records from another group of patients, 18 with unilateral and 8 with bilateral cleft lip and palate, were studied. In these cases the cleft of the hard palate had been repaired in infancy, using a vomer flap procedure. The results indicated that midfacial growth and dental occlusion of the unilateral cleft sample was significantly better in patients whose closure of the hard palatal cleft had been delayed to the stage of mixed dentition than where repair had been performed with a vomer flap in infancy. No differences were found, however, between similar subgroups with bilateral cleft lip and palate. 相似文献
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Successful surgical repair of the unilateral cleft lip and nose deformity, defined as normal orbicularis oris function and near-perfect symmetry of the repaired lip and nose, demands that the surgeon possess complete understanding of the embryology and anatomy of the midfacial defects. The surgical approach to repair of the unilateral cleft lip/nose should place great emphasis on achieving symmetry, not only with the lip segments but also perhaps even more importantly with the nasal tip. The reconstruction should recreate an intact fully functional orbicularis oris muscle across the cleft and camouflage the scar optimally. We have found that modification of the Millard rotation-advancement flap technique, with particular attention to the primary nasal repair, provides the best outcomes. In patients who have undergone primary repair of the lip and/or nose deformity, secondary rhinoplasty is generally required, regardless of the technique used at the primary repair. The degree of nasal deformity, however, is less severe following primary repair of the asymmetric nasal tip. We have found that the sliding flap cheliorhinoplasty, Wang's modification of the Vissarionov technique, provides excellent results for most secondary cleft rhinoplasties. 相似文献