唇裂的鼻小柱侧面皮瓣修复法

为唇裂患者塑造一个正常唇的美好形态,改进现在常用的手术对人中嵴,人中窝和朱缘弓这三种个重要美容结构的塑造中的缺欠,使修复后的嘎满,松动。方法在鼻小柱裂面形成一个矩形瓣,将其与人中一起垂直下降,被充裂侧唇人中的长度不 和保持朱缘弓在下降的正常位。     

Bilateral reverse U incisions and separately placed columella relaxation incision for correction of bilateral cleft lip nose deformity

The reverse U incision method has been employed for the correction of the unilateral cleft lip nose deformity for more than twenty years with satisfactory results. It has some columella lengthening effect and thus has proved to be useful for the correction of nasal deformities of bilateral cleft lip. To augment its columella lengthening effect a columella relaxation incision is added to the bilateral reverse U incision for the correction of the bilateral cleft lip nose deformity. This results in a reconstructed columella of satisfactory length and width.     

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。     

The triple swing technique – a method to correct the soft tissue asymmetry in unilateral cleft lip nose deformities

The correction of the nasal deformity in cleft lip patients is not only a decisive step in secondary treatment but also a very important step towards patient rehabilitation. The stigma of the cleft lip patient is mainly exhibited by the asymmetry of the nasal entrances. Many operative procedures, some of which cause extensive additional scarring, have been suggested in order to remove this typical feature in cleft lip patients. Once symmetry in the cartilaginous structures is achieved the problem of considerable soft tissue asymmetry remains. Focusing on that a triple swing flap technique was developed, this has been proved to be a safe and reliable concept to achieve soft tissue symetry of the nostrils in cleft lip patients. So far the method described in this paper has been successfully used in 201 patients. Received: 28 November 1997 / Accepted: 5 January 1998     

改良Millard法修复单侧重度完全性唇裂

目的：探讨一种修复重度完全性单侧唇裂的方法。方法：应用改良Mi11ard法与裂隙缘粘膜瓣联合应用修复单侧重度完全性唇裂，笔者自2000年始应用此法对单侧完全性重度唇裂的鼻槛修复及口、鼻瘘口封闭、鼻堤重建效果满意。21例患者创口均Ⅰ期愈合。所有病例经术后复查效果满意。结果：该组病例在唇裂修复的同期行口、鼻瘘口之完善封闭。结论：此方法适用于单侧重度完全性唇裂且齿槽骨裂隙较宽大者。     

口轮匝肌精细化解剖修复矫正单侧唇裂术后继发畸形

目的 探讨单侧唇裂术后继发畸形功能性修复的方法.方法 采用基于对口轮匝肌的鼻束、鼻唇束、唇束进行精细化的解剖分离和精确复位的综合手术方法矫正单侧唇裂继发畸形.结果 2003年1月至2008年10月,于临床应用96例,术后患者唇、鼻形态和功能均得到明显改善.85例获得随访,时间为3个月至5年,患者满意度达94.1%(80/85例).结论 对口轮匝肌进行精细化解剖、精确复位,是单侧唇裂术后继发畸形获得良好治疗效果的重要保障.     

Management of the cleft lip deformity

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.     

22q11 Deletion in children with cleft lip and palate--is routine screening justified?

OBJECTIVE: To ascertain the prevalence of 22q11 deletion in children with a diagnosis of cleft lip and/or palate that had been referred to the Cleft Lip & Palate Service, Newcastle-upon-Tyne. DESIGN: Retrospective analysis of results of 22q11 FISH testing performed in all such referrals. PARTICIPANTS: 191 children, of whom 13 had a bilateral cleft lip and palate, two had a median cleft, 77 had a cleft palate only, 44 had a unilateral cleft lip, 47 had a unilateral cleft lip and palate and eight had a submucous cleft palate. RESULTS: nine patients had a positive 22q11 FISH test. CONCLUSION: This represents a higher percentage than has been previously reported. All children with cleft lip and/or palate should routinely have a 22q11 FISH test in view of the implications of a diagnosis of velocardiofacial syndrome.     

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.     

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).     

Epidemiology of orofacial clefts in Finland: a review

Epidemiological studies on clefts in Finland seem to give support to the following theories: 1. Both genetic and environmental factors seem to play a role in the pathogenesis of cleft lip and/or cleft palate, which in the majority of cases are probably two different anomalies. 2. The incidence of cleft lip and/or cleft palate in Finland has increased, probably because of a change in the environmental factors. 3. The incidence of cleft palate in Finland is higher than anywhere, which seems to be the result of differing genetic factors. 4. The exogenous factors remain unidentified, but in cleft lip and/or cleft palate parallel fluctuations and an increasing trend have been noticed, arguing for similar and simultaneous factors. 5. More patients with cleft palate than cleft lip/palate have "cleft syndromes."     

双侧唇腭裂婴幼儿正畸与外科治疗新技术——术前鼻-牙槽骨塑形和早期同期唇-鼻-牙槽整复术

目的：探索双侧唇腭裂婴幼儿术前鼻-牙槽骨塑形及同期唇-鼻-牙槽整复术的时机、方法、特点,并进行其疗效的初步观察。方法：对21例双侧唇腭裂婴幼儿进行了术前鼻-牙槽骨塑形和同期唇-鼻-牙槽整复术。术前鼻-牙槽骨塑形主要包括前颌后退、牙槽骨间隙的关闭、唇的牵张及鼻的矫形;同期唇-鼻-牙槽整复术包括牙龈-牙周膜-牙槽骨整形术及改良长庚式双侧唇裂唇鼻同期整复术。结果：21例行术前鼻-牙槽骨塑形的患者前唇后退充分;唇裂隙宽度变窄,裂隙两侧唇组织适度牵张;鼻小柱延长及鼻塌陷畸形明显改善;牙槽裂隙变窄为1～2mm。19例术后患者经1～5年随访,结果表明：唇鼻形态良好;前庭沟连续;口-鼻腔瘘封闭;16例上牙槽连续、稳定,但部分病例牙槽高度、宽度稍嫌不足,其中13例患者在原牙槽裂隙处长出乳齿。结论：双侧唇裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨,术前进行正畸鼻-牙槽突塑形和早期同期唇-鼻-牙槽整复术是一种实用、无创、安全、可行、经济、值得借鉴的序列治疗方法。     

Cleft lip repair by soft-tissue expansion.

I report herein a newly devised method of cleft lip repair that involves the expansion of cheek skin by tissue expander and transferring the scar from the philtrum to the nasolabial fold, or reducing a broad scar to a finer and less conspicuous one without leaving tension. The method, having been applied in three patients with good results, is thereby recommended for patients with severe cleft lip deformity wherein a tight lip is present.     

运用膨体聚四氟乙烯补片行双侧唇裂术后鼻畸形矫正

目的：通过运用膨体聚四氟乙烯补片加强两侧鼻翼软骨的强度,探索理想的双侧唇裂术后鼻畸形矫正方法。方法：运用膨体聚四氟乙烯补片加强两侧鼻翼软骨强度的方法对30例双侧唇裂术后鼻畸形患者行鼻畸形矫正术。结果：30例患者鼻翼塌陷畸形均得到了明显地改善,18例随访患者伤口愈合良好,无一例发生排异反应。结论：膨体聚四氟乙烯补片是一种理想的植入材料,通过运用这种材料,可以使双侧唇裂术后鼻畸形矫正术达到满意的效果。     

Cleft surgery in East timor: the first four years

BACKGROUND: Following the vote for independence in 1999, this team commenced the first coherent reconstructive surgical service in East Timor. The aim of this paper is to report the cleft lip and palate surgical experience during the 4 years since independence. METHODS: From June 2000, a record of all cleft surgical procedures carried out by our team in East Timor has been maintained. This has been reviewed to identify the clinical experience, procedures carried out and the outcomes of the cleft population in this, the poorest and newest, nation in Asia. RESULTS: From the 519 reconstructive surgical procedures carried out by this team in East Timor during the first 4 years, 267 were for cleft lip and palate deformity. Cleft lip and nose repairs were most commonly undertaken, although over the period of the study increasing numbers of cleft palate repairs were evident, reflecting the developing confidence in the service by the local population. CONCLUSION: The establishment of a regular, consistent cleft lip and palate surgical team in East Timor has not only seen the successful correction of a large number of untreated cleft patients, but has also contributed to a restoration of trust in the newly developing health system in East Timor.     

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。     

三叶瓣修复双侧唇裂术后鼻唇畸形25例分析

目的:通过对双侧唇裂术后鼻唇畸形的分析，探索双侧唇裂术后继发鼻唇畸形矫治的一种理想方法。方法:前唇设计出三叶瓣后，先对移位的组织进行完全游离及复位，再将三叶瓣向鼻小柱方向掀起，延长鼻小柱及抬高鼻底。结果:1999年11月至2002年2月，共矫治双侧唇裂术后继发畸形患者25例，术后三叶瓣血运良好，鼻尖抬起，鼻小柱延长，鼻底外形满意，上唇突度增加。术后切口均Ⅰ期愈合，随访2周至18个月，临床效果满意。结论：该手术方法是矫治双侧唇裂术后继发畸形的一种选择术式，本法对前唇较小、上唇松弛的双侧唇裂术后畸形患者有显著疗效。     

根据口鼻轮廓设计单侧唇裂Ⅱ期修复手术

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.     

单侧唇裂继发鼻畸形自体肋软骨修复术临床体会

目的:分析单侧唇裂继发鼻畸形的产生机制,探讨单侧唇裂继发鼻畸形的治疗方法.方法:采用自体肋软骨移植修复单侧唇裂继发鼻畸形.结果:本组患者共32例,随访时间1～10月,均取得了良好的治疗效果.结论:自体肋软骨移植对单侧唇裂继发鼻畸形有良好的治疗效果.     

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.