Management of the cleft lip deformity

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).     

Repair of unilateral cleft lip: the rotation-advancement operation

The most obvious deformity in a unilateral cleft of the lip is asymmetry of the lip and nose. Operation must repair the cleft, lengthen the lip, restore muscle continuity, and create an adequate labial sulcus. Simultaneous correction of the nasal deformity should be carried out to the greatest extent possible at the same time. The rotation-advancement repair has advantages over other repairs in scar placement, correction of the nasal deformity, and conservation of lip and nose tissue. If revision of the lip or nose is required, it can be accomplished more easily following the rotation-advancement repair than other techniques.     

红唇粘膜瓣修复单侧唇裂术后继发红唇畸形

目的：探求一种新的矫正单侧唇裂术后继发畸形的手术方法。方法：应用红唇粘膜瓣技术矫正单侧唇裂术后继发畸形中的红唇畸形。结果：所有病例术后全部一期愈合,无粘膜瓣坏死,术后红唇形态满意。结论：红唇双叶瓣技术可以同时矫正口哨样畸形,加强唇珠形态,减薄裂隙外侧红唇粘膜厚度等多种红唇畸形,术后效果确切,值得推广。     

转移粘膜肌瓣加深前庭沟术式在单侧唇裂修复中的应用

目的:探讨一种转移健侧粘膜肌瓣加深前庭沟减少皮肤切口的术式在单侧唇裂修复中的临床效果。方法:利用裂隙健侧粘膜肌瓣加深前颌部前庭沟,达到延长健侧唇高恢复唇珠外形的目的,解剖复位口轮匝肌,矫正鼻唇畸形,减少皮肤切口及瘢痕。结果:采用该术式修复单侧唇裂44例,经1~2年随诊,患者唇部皮肤瘢痕不明显,唇弓唇珠外形满意,鼻小柱偏斜鼻翼外侧脚移位得到矫正,前颌部前庭沟深度增加。结论:该手术设计在单侧唇裂修复中值得推广。     

The cleft lateral lip element: do traditional markings result in secondary deformities?

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.     

婴幼儿先天性唇裂早期修复同期行鼻畸形矫正初步报告

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。     

单侧唇裂继发畸形的美学修复

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.     

Cleft lip-nose repair technique: sequential repair

The results of repairing cleft lip by aesthetic plastic surgery are now excellent. However, the cleft lip-nose deformity is still very difficult to repair with the present techniques. A technique that can repair the cleft lip-nose deformity with good results is presented. The technique is divided into three parts: Part I consists of nasal repair of the primary cleft lip. Part II is nasal reconstruction as a secondary operation with or without lip repair. For example, nasal reconstruction may be secondary to repair of deformities of the sill, rim, limen nasi, septum, or nasal bones. Part III is an aesthetic nasal operation such as rhinoplasty, mentoplasty, or zygomaplasty.     

Cleft lip-nose repair technique: Sequential repair

The results of repairing cleft lip by aesthetic plastic surgery are now excellent. However, the cleft lipnose deformity is still very difficult to repair with the present techniques. A technique that can repair the cleft lip-nose deformity with good results is presented. The technique is divided into three parts: Part I consists of nasal repair of the primary cleft lip. Part II is nasal reconstruction as a secondary operation with or without lip repair. For example, nasal reconstruction may be secondary to repair of deformities of the sill, rim, limen nasi, septum, or nasal bones. Part III is an aesthetic nasal operation such as rhinoplasty, mentoplasty, or zygomaplasty.     

应用瘢痕组织瓣修复单侧唇裂继发鼻畸形

目的：探讨上唇瘢痕组织瓣在单侧唇裂继发鼻畸形矫治术中的应用。方法：应用Millard术式原理，不切除上唇瘢痕，而是用以形成两型瘢痕组织瓣，用来矫治不同情况的鼻畸形。结果：1985年起应用本法共矫治单侧唇裂继发鼻畸形51例，皮瓣全部成活，效果良好。结论：本法增加了可供利用的组织量，适用于矫治可供利用的组织量不足时的单侧唇裂继发鼻畸形。     

Modification of Reichert's technique based on natural landmarks and individual designs for unilateral repair of cleft lip.

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.     

改良Millard术式矫正单侧唇裂继发畸形

目的:对Millard术式进行改进以常规用于矫正单侧唇裂继发畸形。方法:在矫治单侧唇裂继发畸形时,常规应用仿Millard术式,并结合上唇瘢痕组织瓣,对所有唇、鼻畸形进行解剖复位。结果:应用本法共矫治单侧唇裂继发畸形58例,皮瓣全部成活,矫治畸形效果良好。结论:根据唇裂继发畸形的特点改进Millard术式,形成了与唇裂修复术不同的唇裂继发畸形矫治术专用术式。     

Abbe’s瓣修复双侧唇裂术后继发畸形患者围手术期护理

目的:探讨Abbe’s瓣修复双侧唇裂术后继发畸形患者的围手术期观察与护理措施及效果。方法:回顾性分析2008年7月～2012年6月我科收治15例选用Abbe’s瓣修复双侧唇裂术后继发畸形患者的临床资料。结果:15例患者未出现术后并发症,唇交叉瓣成活,伤口愈合良好,鼻唇畸形得到矫正,功能外形大为改观,患者心理状态获得促进和最大程度的康复。结论:安全、有效的围手术期观察与护理是Abbe’s瓣修复双侧唇裂术后继发畸形手术成功与否的重要保证。     

Modification of Reichert's technique based on natural landmarks and individual designs for unilateral repair of cleft lip

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.     

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。     

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。     

Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty.

A total of 45 patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. We reviewed 35 of them. Out of these, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. The age range of the patients was from 3 years to 56 years. A reverse-U incision with V-Y plasty was used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. A bilateral reverse-U incision and a trans-columellar incision were used in the four patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were used to ensure firm contact between the nasal skin and the redraped reverse-U flap. A composite graft for columellar lengthening was used in six cases of severe unilateral cleft lip nasal deformity and the four cases of bilateral cleft lip nasal deformity. Ancillary procedures included correction of a lateral displacement of the alar base, lip scar revision, a cartilage graft for tip augmentation, iliac bone grafting for correction of hypoplasia of the maxilla or for an alveolar cleft and corrective rhinoplasty. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 months to 26 months, with an average of 18 months. The final results were evaluated based on the degree of symmetry of the nostrils, the redraping of the alar-columellar web and the exposure of the nostrils. Good results were obtained in 29 patients where alar-columellar web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was achieved. Four patients had fair results and two patients had poor results. In conclusion, we suggest that the reverse-U incision with V-Y plasty is a useful method for achieving symmetry of the nostrils in cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.     

Revision of the cleft lip nose

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.     

解剖学修复单侧唇裂术后继发人中嵴畸形的临床研究

目的 探讨单侧唇裂术后继发唇畸形患者人中嵴平坦或凹陷畸形的手术修复方法.方法 60例单侧唇裂术后继发畸形患者,随机分为两组(n=30),分别通过口轮匝肌垂直肌瓣和口轮匝肌榫卯型肌瓣矫正人中嵴畸形.根据术后患侧人中嵴高度、动态表现、手术瘢痕宽度以及患者的满意度,制定量化评分标准进行综合评价.结果 60例患者伤口均一期愈合.术后随访6个月,口轮匝肌榫卯型肌瓣矫正人中嵴高度、患者满意度等均明显优于口轮匝肌垂直肌瓣组,差异有统计学意义(P＜0.05).结论 根据口轮匝肌解剖学结构,利用榫卯型肌瓣修复唇裂术后继发人中嵴畸形有重要意义.     

鼻黏膜软骨瓣Z成形术修复单侧唇裂继发严重鼻畸形

目的 探讨一种单侧完全性唇裂继发严重鼻畸形的修复方法.方法 根据健侧鼻翼饱满度,于患侧鼻翼凹陷区做Z成形术设计,形成上下两鼻翼黏软骨瓣,通过交错换位,整体延长了短缩的患侧鼻翼软骨瓣的长度,再将重组的患侧鼻翼与健侧悬吊,恢复患侧鼻翼正常的解剖形态,以达到鼻畸形修复的目的.结果 12例单侧唇裂继发严重鼻畸形的患者术后两侧鼻翼饱满、对称,两侧鼻孔形态接近,外形满意.结论 患侧鼻翼黏膜软骨瓣Z成形术,对于修复严重的单侧完全性唇裂继发鼻畸形是一种良好的术式选择.