单侧唇裂术后的鼻有解剖学研究

为探讨组织错位及组织发育不足与单侧唇裂鼻畸形的关系，对３８例伴有鼻畸形的单侧唇裂术后患者在鼻畸形修复术听健患侧鼻翼软骨大小及相对位置进行观察和测量，发现均存在患侧鼻翼软骨错位，若伴有患侧鼻软骨发育不足则鼻畸形更加严重。说明患侧鼻软骨组织错位及发育不足是造成唇裂鼻畸形的局部因素。     

单侧唇腭裂外鼻软骨的外科解剖

为探讨单侧唇腭裂外鼻软骨的解剖异常与鼻畸形的关系，对６例单侧唇腭裂死婴的外鼻部进行解剖，发现患侧鼻翼软骨及鼻中隔软骨发生了组织错位，与鼻畸形的产生有明确的对应关系；统计学处理结果显示，健、患侧鼻翼软骨的大小差异无显著性。说明组织错位是单侧唇腭裂鼻畸形的病理解剖的基础之一。     

自体肋软骨移植治疗单侧三度唇裂术后晚期鼻部畸形

单侧三度唇裂(或唇腭裂)常伴有明显的鼻部畸形。这种鼻部畸形在患儿行唇裂修复时往往不能达到一期整复,原因是唇裂修复多在婴幼儿时施行,由于患儿年幼,鼻部尚在发育,不易施行广泛的鼻翼软骨整形手术。对鼻翼软骨的广泛分离和修整,据报道有可能影响鼻部的生长和发育,故单侧三度唇裂修复术后常伴有鼻部的继发畸形。单侧三度唇裂鼻部的畸形,是由于在胚胎第七周时,患侧上颌突与小球突未能达到预期的连合,造成或侧鼻底部的缺裂,而患侧鼻翼则附丽在上颌骨缺裂的门齿凹处。患侧上颌骨的不连合,在以后发育时则向外向后偏移,因而使患侧鼻翼也随之外展,并向下方塌陷,使患侧鼻孔扁平。由于鼻翼的外展,牵拉患侧鼻尖也向下前移位,使鼻小柱在患侧较健侧为短,因而使整个鼻尖部显得扁平而偏低(图1)。     

单侧唇裂鼻畸形的临床研究

唇裂是口腔颌面部最常见的先天畸形 ,患有唇裂者多半都伴发有鼻的畸形。虽然目前关于唇裂的研究取得了可喜的成果 ,但在唇裂鼻畸形方面还存在很多分歧。本文就近几年关于在单侧唇裂鼻畸形方面的临床研究进展论述如下。1　单侧唇裂鼻畸形的解剖1 .1　鼻畸形病理解剖单侧唇裂鼻畸形由于其畸形的严重程度和是否伴有腭裂其病理解剖有所差异 ,但有一些共同点 :1患侧鼻小柱短 ,鼻小柱根部偏向健侧 ;2患者鼻穹窿呈 S型 ;3患侧鼻翼向后下外移位 ;4鼻锥体不对称 ,鼻尖偏向健侧 ,内侧软骨脚分离 ;5鼻翼软骨环状结构破坏中断。1 .2　鼻尖部血液供应对…     

单侧完全性唇裂修复术同期矫正鼻畸形疗效观察

目的探讨婴幼儿单侧完全性唇裂I期修复术同期矫正鼻畸形的手术方法、可行性及其疗效。方法对5l例单侧完全性唇裂患儿采用Millard I或Ⅱ式手术方法修复唇裂,同期对其鼻畸形进行初步矫正,包括：恢复患侧鼻翼脚的水平高度,使之与健侧对称;重建患侧鼻底形态;延长患侧的鼻小柱长度;恢复患侧鼻嵴和鼻孔大小;鼻外形均得到改善。结果所有患儿均随访36～48个月,患侧鼻翼外侧脚上提内移,鼻小柱变长。所有患儿均未明昆增加术后瘢痕,随访期间均未出现患侧鼻翼发育障碍所致畸形加重。结论单侧完全性唇裂患儿均伴有较严晕的鼻畸形,在I期唇裂修复术同期矫正鼻畸形可以在不增加附加切口的情况下,获得更佳的畸形矫正疗效,患儿术后鼻部的美观和对称性可得到进一步改善,对患侧鼻部的发育未见明显影响。     

单侧唇裂术后鼻畸形的二期整复

目的：观察单侧唇裂术后鼻畸形二期整复手术的效果。方法：选择自1997年3月－2001年2月在本科求医的单侧唇裂术后鼻畸形患者中的78例，全部采用鼻小柱基部的飞鸟形切口进路行鼻翼软骨内侧脚上移悬吊术，进行鼻畸形的二期整复，结果：所有病例术后鼻外形有明显改善，鼻小柱居中，双侧鼻孔大小基本相等，鼻翼鼻底丰满，鼻尖高挺。结论：鼻小柱基部飞鸟形切口进路的患侧鼻翼软骨内侧脚上移悬吊术是单侧唇裂术后鼻畸形的二期整复有效的手术方法之一。     

自体软骨移植联合鼻唇肌复位术矫治单侧唇裂术后继发鼻畸形

目的探讨自体鼻中隔软骨与耳软骨联合移植同时行鼻唇肌复位术在单侧唇裂术后鼻畸形矫正中的疗效。方法将松解移位的鼻翼软骨悬吊复位至正常解剖位置,切取自体鼻中隔软骨修整成形后植入鼻翼软骨两内侧脚间,耳软骨植入充填患侧鼻翼,同期行鼻唇肌复位术,重建鼻软骨肌肉环,修复鼻部畸形。结果 26例鼻畸形患者术后不同程度改善,随访2～9个月,鼻外形美观,效果满意。结论应用自体鼻中隔及耳软骨移植重建鼻软骨支架同时行鼻唇肌复位术能有效矫正单侧唇裂术后鼻畸形。     

可吸收内置夹板在单侧唇裂鼻畸形早期整复中的应用

单侧唇裂整复术后常表现为患侧鼻翼软骨塌陷、患侧鼻小柱过短等继发鼻畸形。作者在唇裂整复术中采用可吸收的鼻内置夹板,保护支撑患侧鼻翼软骨,以防因瘢痕挛缩而造成的鼻继发畸形的可能。 材料和方法 选用的可吸收内置夹板为无孔隙的聚乙二醇酸/聚乳酸共聚物,它是一种安全可靠,可缓慢吸收的生物替代材料。研究对象为30     

鼻翼软骨外侧脚悬吊术联合牙槽嵴植骨整复唇裂鼻畸形

目的:探讨单侧唇裂术后鼻畸形整复的有效方法及牙槽嵴裂植骨同期手术的效果。方法:通过经鼻小柱基底的“U”型切口行患侧鼻翼软骨外侧脚悬吊术联合牙槽嵴植骨,整复13例唇裂鼻畸形患者,观察近、远期效果。结果:13例创口全部一期愈合,随访12～38月,鼻翼软骨外侧脚悬吊术联合牙槽嵴植骨对唇裂鼻畸形患者的鼻尖、鼻翼、鼻孔及鼻小柱畸形矫治术后外形满意,同时矫治了鼻底畸形和牙槽嵴裂。结论:该术式对整复单侧唇裂术后鼻畸形是一种可靠的方法,可推广应用。     

单侧唇裂鼻翼软骨组织学观察

目的:探讨单侧唇裂鼻畸形的形成机制,为唇裂鼻整形提供理论基础。方法:单侧唇裂流产胎儿标本1具,解剖双侧鼻翼软骨,并于鼻翼软骨内1/2处、穹隆角、外1/2处、外1/4处垂直于软骨长轴切开,水平包埋,常规组织学处理,HE染色,进行图像分析。结果:内侧角1/2处与穹隆脚处膜边和中央细胞面积、周长、等效圆直径等测量值,健患侧间无显著性差异。外侧角1/2处与1/4处膜边和中央细胞的上述指标健患侧间有差异,患侧各项均小于健侧。健侧软骨4个部位间发育无差异,而患侧间有差异。结论:单侧唇裂患侧鼻翼软骨的外侧脚细胞发育差于内侧脚及中间脚处。     

Correction of the bilateral cleft lip nasal deformity: evolution of a surgical concept.

The origin of the nasal deformity of a bilateral complete cleft lip is both primary (deformation/malformation) and secondary (postoperative distortion). This is an interim report of a personal evolution from staged correction of the bilateral cleft nasal deformity to synchronous repair of the nose and the lip and premaxillary-maxillary clefts. The anatomic concept is that, because of the malpositioned alar cartilages, the columella only appears to be short in an infant with bilateral cleft lip. The technical stratagems to model the nose are: (1) alignment of the premaxilla and (2) anatomic placement of the alar cartilages with sculpturing of the overlying soft tissue.     

Various applications of chondrocutaneous composite grafts in secondary cleft lip nose patients

Composite chondrocutaneous grafts were applied to 12 patients in various forms to repair the columellar deficit, to form the nasal tubercle and nostril sill in cleft lip nose patients. Cleft lip-nose deformity patients with alar cartilage hypoplasia, obtuse angulation of the medial and lateral crura and the resulting plica vestibularis, internal nasal valve problems associated with the weakness of upper lateral cartilages are included in this study and composite conchal cartilage grafts are utilized to achieve a symmetrical and functional result.     

The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.     

Dynamic presurgical nasal remodeling in patients with unilateral and bilateral cleft lip and palate: modification to the original technique.

OBJECTIVE: To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair. METHOD: The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force generated during suction and swallowing. A conventional intraoral plate is built with a nasal extension added to the labial vestibular flange. The nasal extension was modified and consists of three components. The palatal plate is left loose in the mouth to generate a discontinuous but controlled impact directed to the affected nasal structures during suction and swallowing. The principle aim of the DPNR technique in unilateral cases is to improve the deformation of nasal structures by straightening the columella, elevating the nasal tip, and remodeling the depressed cleft side alar cartilages. In bilateral cases, the aims are to elongate the columella and to obtain nasal tip projection. CONCLUSIONS: The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate.     

单侧完全性唇裂术后鼻畸形整复术的临床分析

目的：通过对单侧完全性唇裂术后鼻畸形整复方法的研究和改进,探讨其理想的手术方式。方法：以61例单侧完全性唇裂术后鼻畸形患者为研究对象,其中男性36例,女性25例,年龄分布范围3～34岁,平均年龄14.6岁。根据不同的鼻畸形程度进行鼻唇肌肉的解剖复位,鼻翼及鼻中隔软骨悬吊复位固定,以及肋软骨塑形后移植,纠正鼻翼和鼻小柱的畸形。结果：61例单侧完全性唇裂术后鼻畸形患者术后外形均得到明显改善,移植肋软骨未发生明显吸收,患者局部伤愈合良好。结论：单侧完全性唇裂术后患者鼻畸形的手术治疗应注重强调个性化处理。针对鼻畸形的原因,从软组织及鼻翼和鼻中隔软骨等多方面进行矫正治疗,才能获得更为理想的整复效果。     

双侧唇裂术后鼻唇畸形的修复

目的 报道双侧唇裂术后鼻唇畸形修复的一种新方法。方法 在双侧鼻孔的内侧沿鼻小柱皮肤粘膜交界缘向下达鼻小柱基部并经鼻底向外达外侧脚外侧并绕鼻翼外侧脚弧形向上;在上唇正中上部画出叉形瓣切口线;再在双侧鼻孔底部上唇瘤痕两侧画垂线至唇红缘。然后切开鼻底及鼻翼外侧脚皮肤,在鼻翼内侧脚上端缝合。将叉形瓣向上推形成鼻小柱下端。切除上唇瘢痕组织,必要时可设 Abbe瓣经旋转180°后按粘膜、肌层及皮肤层缝合。10～14天行Abbe瓣断蒂。结果 用该术式对34位患者进行了手术,术后鼻唇外形、鼻小柱长度及鼻孔大小趋于正常。上唇过紧得到了松驰。结论 该术式对双侧唇裂术后鼻唇畸形矫正有用。     

Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip,alveolus, and palate: A clinical report

PatientA 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention.DiscussionThe alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate.ConclusionAs a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.     

Objective tools to analyze the lower lateral cartilage in unilateral cleft lip nasal deformities

Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.