Augmentation of the Columella-Labial Angle to Prevent the ``Smiling Deformity' in Rhinoplasty

Aesthetic diagnosis of the smiling deformity, which is functional rather than anatomical, is essential to provide the best treatment in rhinoplasty. The nasal tip tends to rotate inferiorly during smiling, and the central upper lip moves superiorly. A posteriorly sloping upper lip with a retrodisplaced columella–labial junction gives an unaesthetic appearance. Downward movement of the tip and a sharper nasolabial angle are usually aesthetically unpleasant. In 28 nasal surgeries, augmentation of the columella–labial angle with cartilage strip grafts has been performed. The augmentation of the angle and additionally cutting of the depressor septi muscle created a wider nasolabial complex, and this angle looks full and more pleasant. This procedure has mainly been used as an additional procedure to standard reduction rhinoplasty in order to improve smiling deformity. Strip cartilage grafts were inserted subcutaneously into the upper lip extending half way to the columella and secured with a transcutaneous suture under the columella–labial angle to prevent misslocation. Augmentation by the cartilage graft together with cutting the depressor septi muscle prevented elevation and shortening of the upper lip, and also drooping of the nasal tip. This procedure provided an aesthetically pleasant appearance both at rest and during smiling.     

Open Rhinoplasty Through a Forked Flap Incision

Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.     

Short columella nasolabial complex in aesthetic rhinoplasty

Many papers describe different approaches for short columella in cleft lip or Negroid noses. Very little has been found in international literature related to these aesthetic rhinoplasties. The scarce skin of the columella, the firm union between the nasal tip and the lip, due to the hypertrophy of the depressor septi nasi muscle, and the low projection of the nasal tip, consequence of the open position of the caudal part of the medial crura, are the cause of this problem. Therefore, the skin, muscle, and cartilage were treated simultaneously. Herein is described a VY composite advanced flap for projecting the tip, suturing both divergent medial crura together and adding the skin and muscle tissues of the lip to the columella. With this flap the tip was projected, the columella was narrowed, the nasolabial angle improved, and the upper lip elongated. Good results could be achieved without using any other cartilage graft or silastic strut. Standard rhinoplasty and septumplasty could be combined with this technique. Inconspicuous scars were observed.     

Melkersson–Rosenthal Syndrome: Reduction Cheiloplasty Utilizing a Transmodiolar Labial Suspension Suture

Melkersson–Rosenthal syndrome is a rare condition which consists of progressive and recurrent orofacial edema, intermittent facial palsy, and lingua plicata. Labial swelling is the most common feature of this syndrome complex. The lips may enlarge up to three times their normal size, resulting in aesthetic deformity and functional disability. Traditional medical interventions are only marginally successful in treating this syndrome. We present a case of Melkersson–Rosenthal syndrome with massive lower lip enlargement, which was successfully treated by combining a fleur-de-lis resection with a transmodiolar labial suspension suture. Five-year follow-up photographs are presented.     

上唇红唇修薄手术方法的改进

传统的上唇红唇修薄手术，切口设计很容易破坏上唇结节（唇珠），术后外形不美。为了在修薄上唇唇红的同时，完整地保存上唇结节，使术后上唇外形更加自然提供一种新的术式。方法是在上唇结节下方与两侧将切口设计成“Ｖ”形，将传统的弧形切口改为曲线切口。并根据唇结节的丰满程度，利用双侧带蒂唇红下组织瓣加高唇结节。临床应用２１例，术后显示美容效果满意。本方法不破坏结节组织。如唇结节不丰满，可利用多余唇红下组织来加高唇结节高度。     

Columellar lengthening using the interdigitation of triangular flaps

The most common and striking feature of the bilateral cleft lip nose deformities is a short columella. This problem can be resolved by lengthening the columella. In this article the authors lengthen the columella using the interdigitation of triangular flaps in the upper lip tissue. The columellar elongation is made by an advancement of nostril tissue and an interdigitation of the triangular flaps. Our method shows good aesthetic results. The triangular flaps that are intersected without excision make the columellar base pyramidal and medially directs the alar bases, narrowing the width of the nostril sills. Though the optimal columellar lengthening procedure can vary according to the deformed anatomy of the nose and lip, this method deserves to be considered especially in patients who have sufficient tissue in their nostril sills.     

Ethnic, Anthropometric, and Lifestyle Associations with Regional Variations in Peak Bone Mass

The study investigated the ability of ethnicity and anthropometric and lifestyle factors to account for differences within subjects in bone mass at different skeletal sites. The subjects were young, adult, Japanese, Filipino, Hawaiian, and white women ages 25–34. In the preliminary analyses, they were divided into thirds based on their BMD z-scores. Thirty-five percent exhibited high variability in bone mass: they were in the upper third at one or more bone sites and in the lower third at one or more sites. Other women had more generalized low bone mass: 25% were in the lowest third for two or more sites, and there were no sites with low bone mass in the upper third. In subsequent analyses, ethnicity, anthropometry, and lifestyle influences were examined as possible predictors of differences in bone mineral content (BMC) between bone sites in bone-size adjusted models. White women had greater BMC at the proximal radius and calcaneus than at the distal radius compared with other ethnic groups. This may be explained by the fact that they had exceptionally wide bone widths at the distal radius. Of the anthropometric variables, fat mass was associated with higher bone mass at sites with higher proportions of cancellous tissue (calcaneus > spine > radius sites). Muscle mass was associated with greater bone mass at the calcaneus and proximal radius than at the spine. For the lifestyle variables, women with greater milk consumption between the ages of 10–24 years had higher spine bone mass than expected from their measurements at the proximal radius. Women 12–17 years of age who had been more active in sports had higher calcaneous bone mass than expected from their spine measurements. As the study participants were still young women, the results suggest that regional differences in bone mass may partly derive from anthropometric and lifestyle influences during skeletal maturation. Received: 6 March 1998 / Accepted: 15 December 1998     

The Effect of Skeletal Remodeling on the Nasal Profile: Considerations for Rhinoplasty in the Older Patient

The effect of continued differential growth of the adult male craniofacial skeleton on the nasal profile is examined in the present study. Two groups of individuals (N= 20) were compared, young (ages 16–23) and old (49–64). A three-dimensional CT scan was created for each individual in a standardized view. The change in position of four skeletal reference points with soft tissue correlates was analyzed. Changes were evaluated in both the vertical and the horizontal dimensions relative to the sella-nasion and to a perpendicular from the sella-nasion. Results show that the area of the maxilla at the pyriform remodels posteriorly with age (p= 0.017), while the position of the other three points does not change in a significant fashion. This suggests that differential growth continues to occur in the aging craniofacial skeleton. Differential growth is further documented by calculating the percentage change in the position of any of the four points: the pyriform changed 80.2% from young to old, while the other points changed only from −9.3 to +22.1%. The craniofacial skeleton is the scaffold for the overlying soft tissues. Because the pyriform aperture represents the skeletal platform for the nasal pyramid, pyriform remodeling in a posterior direction retrudes the nasal profile with age. In addition, loss of pyriform height may distort the normal relationship of the alar base to the columella. These changes require assessment for the optimal result from aesthetic rhinoplasty.     

The extended Abbe flap in the reconstruction of complex midfacial defects

The Abbe flap is most commonly used to repair full-thickness defects of the lip that do not involve the commissure. This well-perfused axial flap is based on the labial branches of the facial artery. The inferior labial vessels have been shown to support a cutaneous territory, including the entire lower lip, chin, and submental skin. Defects extending beyond the confines of the upper lip may be reconstructed with an extended lip switch flap that is based on the inferior labial artery. This "extended" Abbe flap allows functional and cosmetically acceptable repair of the upper lip, medial cheek, columella, and nasal sill. Case presentations illustrate the technique and outcome.     

The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy

Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies, would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning, anesthesia, and increased intra-abdominal pressure. Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane–fentanyl anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages. Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15–20°) positions, and after the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal pressure at 13–16 mmHg), after deflation of the gas, and in the recovery room. Results: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in heart rate. Carbon dioxide (CO₂) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas systemic vascular resistance was decreased in comparison with the baseline. Conclusions: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics during laparoscopic cholecystectomy. Received: 6 November 1998/Accepted: 8 July 1999     

Handport-assisted laparoscopic splenectomy in massive splenomegaly

Background: Laparoscopic splenectomy of normal-sized spleens is performed with increasing frequency. By using a handport, which allows the intraperitoneal introduction of one surgeon's hand, massively enlarged spleens may also be extirpated via a laparopscopy-assisted technique. Methods: Seven patients (54–80 years) with massive splenomegaly (3.5–5.8 kg) underwent handport-assisted laparoscopic splenectomy. All patients had spleens that extended beyond the umbilicus, hypersplenism, and discomfort in the upper left quadrant due to intractable hematological malignancy. Results: Both the operation and recovery were uneventful in five of the patients, but one patient had to be converted to an open procedure due to splenic damage and bleeding, and another was reoperated for hemorrhage from a trocar. The handport allowed splenic protection while the trocars were introduced and instruments changed. It also enabled splenic mobilization, particularly prior to stapling of the hilar structures and dissection of the upper splenic pole. Conclusions: Handport-assisted laparoscopic splenectomy seems to be a viable alternative for massive splenomegaly, but it requires further evaluation with respect to safety, efficacy, and indication. Received: 7 September 1999/Accepted: 12 March 2000/Online publication: 20 July 2000     

Relationship of Spinal Fracture to Bone Density,Textural, and Anthropometric Parameters

To investigate risk factors for spinal fracture, we studied the relationship between the prevalence of asymptomatic spinal fracture and various morphological measures including spinal bone mineral density (BMD) in women. A total of 122 women ranging in age from 55 to 79 years were studied. The group consisted of 46 women aged 55–59 years (18 with fracture), 51 women aged 60–69 years (26 with fracture), and 26 women aged 70–79 years (14 with fracture). BMD of cortical and trabecular bone from L1 to L3 was measured using quantitative computed tomography (QCT). Run-length analysis was applied to evaluate the spinal trabecular textural features using CT images; the texture indices which represent the mean width of trabeculae (the T-texture) and that of intertrabecular spaces (the I-texture) were obtained. Anthropometric factors including body weight and height, psoas muscle area, and vertebral bone volume were measured using CT images. Among the various factors, trabecular BMD in women aged 55–69 years showed the highest odds ratio for the presence of fracture per standard deviation (SD) decrease in bone density. However, in women aged 70–79 years, the highest odds ratio was observed for trabecular texture index but not for trabecular BMD. The I-texture in women aged 55–59 years, the muscle area in women aged 60–69 years, and cortical BMD and muscle area in women aged 70–79 years were also considered significantly related to the risk of fracture. Received: 31 December 1995 / Accepted: 24 July 1996     

唇珠重建术的探讨

目的：探讨一种简便的唇珠重建方法。方法：在上唇口内近边缘处作倒V形切开,应用V-Y改形原理,将皮瓣往唇缘处推进,加上唇系带二侧旋转瓣相嵌缝合,重建唇珠。结果：皮瓣血运、存活良好,重建唇珠外形满意,表面看不到瘢痕,是一种简单、方便、理想的唇珠重建方法。随访3～15个月,平均12个月,皮瓣质地优良,瘢痕不明显,无挛缩,唇形生动自然,立体感强。远期效果满意。结论：运用V-Y改形术加上唇系带二侧旋转瓣相嵌缝合术是进行唇珠重建的理想术式。手术设计及操作简便,皮瓣血运可靠,能理想地重建缺损的唇珠,术后不挛缩,瘢痕不明显,远期效果可靠。     

Epidemiology of Minimal Trauma Rib Fractures in the Elderly

We determined the secular trends in the number and incidence of the elderly's minimal trauma rib fractures (typically caused by a fall from standing height or less) in Finland in 1970–1994 by collecting from the National Hospital Discharge Register all patients aged 60 years or more who were treated in Finnish hospitals in 1970–72, 1974–75, 1978–80, 1983–85, 1988–89, and 1991–94 for first rib fracture. The age-adjusted incidence of fractures slightly increased in both sexes, from 36 (1970) to 40 (1994) in women, and from 63 to 71 in men; in younger patients (aged 20–49 years) this incidence decreased from 10 to 6. The age-specific incidences increased especially in women aged 85 years and over, from 108 (1970) to 251 (1994). If this trend continues, the total number of hospital-admitted, minimal trauma rib fractures in Finnish elderly will increase from 576 (1994) to almost 1000 in the year 2010. We conclude that the number of the elderly's minimal trauma rib fractures is increasing in Finland, largely due to the increasing number of elderly in the Finnish population. Therefore, effective preventive measures are needed to keep this problem under control. Received: 14 June 1996 / Accepted: 21 May 1997     

Bone Mineral Density in Athletes During and After Career: A Comparison Between Loaded and Unloaded Skeletal Regions

Bone mineral density (BMD) was measured in the upper part of the skull, the femoral neck, and the total body by dual energy X-ray absorptiometry in 56 male and 33 female active athletes, 18–40 years of age, together with 64 male ex-weight lifters, 35–79 years of age. The active athletes were compared with 41 male and 54 female controls, the ex-weight lifters with 133 male controls. The purpose of the study was to see if BMD in the upper part of the skull, a region virtually unaffected by physical load, is different in athletes and controls. The male athletes had a 3% higher BMD for the total body and 12% for the hip, whereas the BMD for the upper part of the skull was 10% lower than controls. Corresponding BMD values for the female athletes were 4% higher for total body and 10% for the femoral neck, and the upper part of the skull was 7% lower than in controls. After 65 years of age there was no difference in BMD comparing ex-weightlifters and controls. Using a constructed ratio BMD total body to BMD upper part of the skull, the ex-weight lifters had 10% higher values also after age 65. It appears that bone mass is higher in weight-loaded areas and lower in an unloaded region, such as the upper part of the skull, in exercising athletes. After cessation of the active career, the bone mass approaches that of the controls and after 65 years of age, no difference was found comparing ex-weight lifters and controls. Due to the apparent bone mass shift from unloaded skeletal regions to loaded skeletal regions that seems to take place in active athletes, the constructed ratio, BMD total body to BMD upper part of the skull, seems to discriminate the influence on the skeleton in a more sensitive way than measuring the BMD in defined skeletal regions on their own. By using this constructed ratio, the influence on bone mass of physical exercise early in life is also detectable at older ages. Received: 6 June 1995 / Accepted: 1 April 1996     

The Effect of Intermittent Slow-Release Sodium Fluoride and Continuous Calcium Citrate Therapy on Calcitropic Hormones, Biochemical Markers of Bone Metabolism, and Blood Chemistry in Postmenopausal Osteoporosis

A detailed examination of calcitropic hormones and biochemical markers of bone turnover, serum chemistry, and blood hematology was performed in 75 postmenopausal women allocated to two groups: placebo plus calcium citrate (400 mg Ca B.I.D.) (n = 36) or intermittent slow-release sodium fluoride (SRNaF, 25 mg B.I.D.) plus calcium citrate (n = 39). After 2 years of therapy, a significant reduction in serum immunoreactive parathyroid hormone (PTH) was seen for both groups (43 ± 18 SD–30 ± 11 ng/liter, in placebo and 46 ± 24–36 ± 10, in SRNaF P < 0.0001 for both groups). Serum 1,25(OH)₂D significantly fell in placebo-treated patients (91 ± 31–75 ± 34 pmol/liter, P= 0.001) but did not change for SRNaF-treated patients. This difference in response between placebo and SRNaF-treated groups was significant, P= 0.005. Urinary hydroxyproline significantly declined during treatment in both groups (130 ± 61–76 ± 38 μmol/day, for placebo and 138 ± 84–84 ± 38 for SRNaF, P= 0.001). Similar decreases in urinary N-telopeptide of type I collagen were also observed for both groups (305 ± 192–252 ± 197 nmoles BCE/day for placebo and 356 ± 230–220 ± 197, P= 0.0001 for SRNaF). Serum carboxyterminal propeptide of type I collagen (PICP) declined significantly in both the placebo and SRNaF groups (118 ± 38–101 ± 36 μg/liter, and 116 ± 47–105 ± 39, P= 0.0027). Serum osteocalcin did not change significantly for either group, but bone-specific alkaline phosphatase (BS-ALPase), another marker of bone formation, demonstrated a significant fall in the placebo group at 2 years of therapy (16.2 ± 6.7 U/liter–12.1 ± 3.5, P= 0.009) and a small increase in the SRNaF-treated patients (13.0 ± 4.1–15.0 ± 4.5). The observed difference in response of BS-ALPase between the placebo and treated groups was significant (P= 0.007). There were no significant changes within or between treatment groups for blood hematology or serum chemistries. Mean values for all parameters remained within established normal ranges. These findings suggest that administration of calcium citrate inhibited PTH secretion and thereby reduced bone resorption in both groups, indicated by a decline in serum PTH, urinary hydroxyproline, and N-telopeptide. A low turnover state of bone may have been produced in the placebo group taking calcium citrate alone, since serum PICP, BS-ALPase, and 1,25(OH)₂D also decreased. The addition of SRNaF prevented serum 1,25(OH)₂D from falling by an unknown mechanism. However, its anabolic action on the skeleton was best reflected by changes in BS-ALPase. Moreover, SRNaF appeared to exert no deleterious effects on blood chemistries or hematology during 2 years of administration. Received: 28 January 1996 / Accepted: 25 April 1997     

Laparoscopic nephrectomy in childrenrid=""id=""Presented in poster format at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), San Antonio, Texas, USA, 24–27 March 1999

Background: Laparoscopic nephrectomy in the adult population is reported with increased frequency. We present our initial experience with laparoscopic nephrectomy in children. Methods: Over a 2-year period, 11 nephrectomies were performed in nine children aged 16 months to 16 years (mean, 6.5 years). All patients were referred due to complications of a nonfunctioning kidney. Seven patients had recurrent urinary tract infections, and two had refractory hypertension. Two patients underwent bilateral laparoscopic nephrectomy. The operation was performed using four access ports measuring 3.5 to 10 mm. Results: All kidneys were removed successfully using a laparoscopic technique. The average length of the operation was 163 min per kidney (range, 90–420). The estimated blood loss was <10–150 ml (mean, 45). No patient required transfusion. Seven patients were discharged home by postoperative day 2. The two patients with the longest operating times were discharged home on postoperative days 4 and 5 due to delay in return of bowel function. Narcotic use was minimal, and all patients enjoyed a rapid return to full activity. Conclusion: Laparoscopic nephrectomy is a viable alternative to open nephrectomy in children. Further experience with this technique is required to establish its efficacy and reduce the operating time Received: 29 April 1999/Accepted: 29 August 1999/Online publication: 17 April 2000     

Minimally invasive surgery for posterior gastric stromal tumors

Background: Because involvement is extremely rare, surgery for gastric stromal tumors consists of local excision with clear resection margins. The aim of this study was to report the results of a consecutive series of nine patients with posterior gastric stromal tumors that were excised using a minimally invasive method. Methods: Patients received a general anesthetic before placement of three laparoscopic ports— a 10-mm (umbilical) port for the telescope and two working ports, a 12-mm port (left upper quadrant) and a 10-mm port (right upper quadrant). Grasping forceps were placed through an anteriorly placed gastrotomy to deliver the tumor through the gastrotomy into the abdominal cavity, thus allowing an endoscopic linear cutter to excise the tumor with a cuff of normal gastric tissue. Results: Nine consecutive patients with a median age of 73 years (range, 47–83) were treated. In seven patients, laparoscopic removal of the tumor was achieved. Two patients required conversion to an open operation because the tumor could not be delivered into the abdominal cavity. The median length of postoperative stay for the seven patients in whom the procedure was completed laparoscopically was 3 days (range, 2–6). Conclusions: Posterior gastric stromal tumors can be removed safely using this minimally invasive method. Delivery of the tumor through the gastrotomy is essential for success. Received: 30 April 1999/Accepted: 12 July 1999     

Clinical Observations with a New Specific Assay for Bone Alkaline Phosphatase: A Cross-Sectional Study in Osteoporotic and Pagetic Subjects and a Longitudinal Evaluation of the Response to Ovariectomy,Estrogens, and Bisphosphonates

The purpose of this study was to examine the serum levels of bone alkaline phosphatase (BALP) measured with a new assay in normal and in osteoporotic women, and to evaluate prospectively its responsiveness to changes of bone metabolism. The following groups of subjects were studied: (1) 95 healthy women (44–75 years) (22 pre- and 73 postmenopausal) and 35 osteoporotic women [vertebral bone mineral density (BMD) more than 2.5 SD below the normal adult mean]; (2) 10 women (44–50 years) ovariectomized (OVX) for benign uterine diseases, examined before and 12 months after surgery; (3) 16 OVX women (36–54 years), examined before and after 12 months of transdermal estrogen replacement therapy (50 μg/day); (4) 12 previously untreated pagetic patients (4 women and 8 men, 50–80 years), examined before and 3 months after the I.V. administration of clodronate (600 mg) or alendronate (5 mg) for 2 consecutive days. The median BALP value was 11.6 U/liter (25–75th percentiles: 10.5–12.7; range 7.7–19.3) in healthy premenopausal (PreMP) women and significantly higher (median: 16.8 U/liter; 25–75th percentile: 13.8–21.8; P < 0.01) in postmenopausal (PostMP) women. There was a clear age-related increase in normal subjects (r = 0.43; P < 0.001). In the osteoporotic group, BALP levels, as well as other biochemical parameters of bone turnover, were not significantly different from those of normal women when adjusted for age. In OVX women, BALP levels showed a marked increase 12 months after surgery (median: 113%; 25–75th percentile: 87–139%), significantly higher than the increase of total ALP (median: 43%; 25–75th percentile: 25–66%; P < 0.001), and similar to the increases of serum osteocalcin and urinary hydroxyproline. Transdermal estrogen treatment prevented the BALP increase, even if no reduction was observed; total ALP showed a similar behavior. The basal levels of BALP were significantly elevated in pagetic patients (median: 91 U/liter; range 18–610 U/liter) and correlated to the scintigraphic extent of the disease (r = 0.76; P < 0.01). Three months after the I.V. administration of bisphosphonates, the decrease of BALP was more marked than that of total ALP (median: −54% versus −41%; P < 0.05). In conclusion, these results suggest that BALP measurement with this immunoassay may be clinically useful, and more sensitive than total ALP, in the assessment of bone turnover during changes of the estrogen status as well as in monitoring the effects of treatments that modify the metabolic activity of the skeleton. Received: 25 January 1996 / Accepted: 3 May 1996     

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.