长庚法修复单侧不完全性唇裂

目的探讨长庚法功能性修复单侧不完全性唇裂的疗效.方法应用长庚法修复46例单侧不完全性唇裂.在设计旋转切口时,长庚法与Millard法相似;在设计患侧唇的推进瓣时,应尽量避免鼻翼基底的水平切口,更不宜做绕鼻翼外脚的弧形切口;C唇瓣向外、上旋转与鼻翼基底的口轮匝肌缝合,以提供对鼻翼的支撑及加高鼻堤;鼻底的宽度应参照健侧并通过C瓣的旋转实现.结果 46例中,44例的创口Ⅰ期愈合,1例抓伤、1例湿疹致创口Ⅱ期愈合.患侧唇的高度、长度与健侧一致,患侧鼻底宽度适中且有较好的丰满度,鼻翼外脚形态自然,患侧人中嵴较明显,红唇部形态自然、丰满,唇珠微突,鼻小柱形态好.结论长庚法功能性修复单侧不完全性唇裂,定点简单,操作方便,创伤小,术后能获得良好的鼻唇外形和功能.     

应用Fisher法亚解剖单位修复术治疗不完全性单侧唇裂26例分析

目的 探讨Fisher法亚解剖单位修复术在不完全性单侧唇裂修复术中的应用效果.方法 以裂隙侧鼻小柱基底为起点,向下做与健侧人中嵴镜像对称的直线切口,在唇红嵴上方折向裂隙近中侧唇峰点.这两条折线拉直后可产生约1mm的延长效果.如果唇峰仍然下降不足,在折点处插入一个小三角瓣.鼻底部切口围绕裂隙侧鼻小柱基底皱褶至鼻腔,保留裂隙远中侧鼻槛,并在裂隙远中侧唇部设计与裂隙近中侧创面相吻合的切口.利用侧方唇的唇红三角瓣修复近中侧唇红缺损.结果 26例术后即刻观测到两侧唇峰等高,两侧鼻底等宽.随访3～24个月,1例唇高下降不足,25例两侧人中嵴及唇弓嵴协调,鼻底切口隐蔽,小三角瓣处无明显瘢痕.结论 Fisher法单侧唇裂亚解剖单位修复术可以有效降低裂隙侧唇峰,术后瘢痕与唇鼻部亚解剖单位分区线吻合,技术易于掌握.     

个性化树酯鼻模具在单侧唇裂术后继发鼻畸形修复中的应用

目的：探讨个性化树脂鼻模具在单侧唇裂系列治疗中鼻畸形修复术后的塑形及支撑作用。方法：使用阴模、阳模转换的方法制作出个性化，并具有方向性的树脂鼻模具。10例单侧唇裂术后继发鼻畸形的患者，年龄为10～12岁，在手术后持续配戴该模具3～6个月。对照组10例患者没有使用，或者使用传统鼻管。结果：使用个性化树脂鼻模具支撑的较没有使用或使用传统鼻管支撑的患者，无论在鼻外形还是通气功能方面都有明显改善。结论：个性化树脂鼻模具对患侧鼻孔的塑形符合鼻部的生物力学原理。并通过长期、持续、温和、有方向性的外力来维持手术的预想效果和改善患侧鼻孔的通气功能。     

埋线平衡肌力法在单侧唇裂鼻畸形中的临床应用

先天性唇裂伴发鼻畸形,是临床修复的难点。一般认为,造成唇鼻部畸形病理基础的主要因素有外鼻软骨解剖异常,平衡肌力及颌发育异常等三大因素。主要表现为鼻尖偏向患侧或扁平,鼻小柱弯曲,鼻堤增宽、凹陷,鼻前庭皱褶畸形,鼻翼两侧明显不对称或宽大畸形等,修复较为困难。近年来,笔     

鼻美学亚单位分区在鼻端缺损修复中的应用

目的 探讨应用鼻美学亚单位分区原则修复鼻端缺损的方法和临床效果.方法 以鼻美学亚单位为基础,将鼻端缺损部位周围的正常皮肤或瘢痕皮肤翻转作为衬里,废弃亚单位区域内其余正常皮肤组织,以额部皮瓣覆盖鼻端亚单位的皮肤缺损.自2000年8月至2011年7月,修复鼻端皮肤软组织缺损患者10例.结果 本组10例患者创面均Ⅰ期愈合,术后随访 1～18 个月,鼻外形轮廓良好,受区皮肤组织在色泽、质地等方面与周围皮肤匹配良好.结论 按照鼻美学亚单位分区来修复鼻端缺损,能获得满意的功能和美学效果.     

单侧不完全性唇裂改良修复术

目的 探讨一种单侧不完全性唇裂的手术方法及治疗效果.方法 选择18例出生后3～6个月的先天性不完全性唇裂患儿.手术定点参考健侧人中嵴,采用唇红缘上皮肤小三角瓣法加唇上方弧形切口,彻底分离鼻翼基底的肌肉,重建完整口轮匝肌肌环,并保持唇高一致.结果 切口缝合线位于人中嵴处;上唇解剖标志明显;人中凹居中,皮肤瘢痕不明显;手术效果满意.结论 此方法是修复不完全性唇裂的一种简单有效的手术方法.     

改良单侧不完全性唇裂修复术的探讨

目的：探讨改良的单侧不完全性唇裂修复术式及人中嵴形态的修复方法。方法：根据患者两侧唇峰高度差分别选择两种不同的术式,对31例单倒不完全性唇裂患者进行恢复唇峰高度、修复口轮匝肌、重建人中嵴、矫治鼻畸形等方法进行综合修复。结果：分别采用两种术式中的一种修复的31例单侧不完全性唇裂患者上唇、人中嵴形态满意,部分接受鼻畸形矫治的患者,鼻畸形基本矫正,随访6个月～2年效果满意。结论：改良的唇裂修复术式用于单侧不完全性唇裂可取得满意的效果。     

Correction of the bilateral complete cleft lip: transformation to a unilateral incomplete cleft lip closure

The complete lip alveolus and cleft palate is the most difficult of all bilateral clefts to treat because of the deformity of and tissue insufficiency in the prolabium. A bilateral concomitant procedure is impractical for treatment of this condition because of the problems that have to be resolved postoperatively, including a short columella, a lack of philtrum, labial horizontal and vertical insufficiency, and vermilion and alveolar vestibulum insufficiency. A two-stage procedure called the transformation method has been developed to circumvent these problems, and the authors present it here. With this method one side is closed completely using the maximum amount of tissue available. Concomitantly, incomplete closure is performed on the other side. The result at the end of the first stage of the procedure is a condition approximating unilateral incomplete closure. The results were obtained from 6 patients who underwent complete bilateral closure and were followed for at least 2 years with satisfactory results.     

Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip

PurposeTo demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction.MethodsThe surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method.ResultsFinite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up.ConclusionForce balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.     

膨体聚四氟乙烯在单侧唇裂术后继发鼻畸形整复术中的应用

目的：探讨膨体聚四氟乙烯材料在单侧唇裂术后继发鼻畸形中的利用及效果分析。方法：取鼻正中蝶形切口加双侧鼻翼缘切口应用膨体聚四氟乙烯加强型补片辅助下矫正鼻尖歪斜、鼻翼塌陷、低鼻畸形;依据Ⅰ期手术所遗留的上唇瘢痕切口行鼻基底和患侧鼻翼基底部填充术。结果：应用膨体聚四氟乙烯加强型补片为66例患者行单侧唇裂术后继发鼻畸形整复术。术后随访6个月～6年,满意者61例,占92.4%,不满意5例,占7.6%,5例患者术后出现伤口感染,将ePTFE假体取出。结论：膨体聚四氟乙烯为单侧唇裂术后继发鼻畸形整复术中治疗鼻尖鼻翼等畸形和面中部塌陷提供了较为理想的软组织替代材料,术后效果满意。     

The philtrum and unilateral cleft lip

Summary A unilateral cleft lip apparently does not lack a philtral ridge on the cleft side even if the elements are variable with the degree of cleft. The objective of primary repair should be to preserve the complete philtrum.     

应用鼻底三角瓣法修复单侧不完全性唇裂

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 66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.