耳甲软骨移植修复单侧唇裂术后鼻畸形的临床研究

目的:探讨耳甲软骨移植修复单侧唇裂术后鼻畸形的临床效果.方法:切取小块耳甲软骨修整折叠后植入鼻小柱内,重建外鼻下端的鼻小柱支架结构,并在鼻小柱基部及患侧鼻翼外侧基部皮下及肌肉层之间进行悬吊,同时对鼻皱褶进行"Z"改形,纠正鼻小柱和鼻翼的畸形.将手术效果分为非常满意、满意、基本满意、不满意、非常不满意5 级,由患者本人、术者和另外3 位頜面外科医师共同评价,结果:各项评价指标的总体满意度均在90%以上.结论: 耳甲软骨移植修复单侧唇裂术后鼻畸形可以取得良好效果.     

Repairing the cleft lip nasal deformity.

OBJECTIVE: The repair of the cleft lip nose and nasal deformity remains a challenging endeavor for reconstructive surgeons. Psychosocially, this complex, multifaceted deformity significantly stigmatizes the patient. Numerous techniques have been advocated by multiple authors for the treatment and reconstruction of these deformities, usually requiring serial staged reconstructions. METHOD: Described is our technique for early primary repair of the cleft lip nasal deformity. The use of multiple suspension sutures to repair the nasal defect facilitates the repair of even very wide cleft lips. CONCLUSIONS: These maneuvers provide an aesthetic and functional repair of the nasal defect in conjunction with the lip repair. Long-term results have minimized the need for surgical revision.     

双侧唇裂术后唇鼻畸形的美容整形术

目的 :探讨双侧唇裂继发畸形美容整形术的技术改进。方法 :采用两侧红唇上缘的小三角瓣插入到原人中的下方来延长上唇 ,及利用 2种方案修复鼻畸形。结果 :双侧唇裂术后唇鼻畸形Ⅱ期美容整形术12例均取得了比较明显的手术效果。结论 :此方法在唇峰重建、唇珠再造、人中凹形成及唇鼻畸形的矫正方面有比较独特的效果     

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.     

Secondary repair of the bilateral cleft lip deformity

A wide prolabial segment with a "whistling" defect used to be a common deformity following bilateral cleft lip surgery when the muscle repair was ignored. Simply revising scars often will be followed by recurrence of the deformity. An adequate muscle repair is the basis for a successful and permanent correction. The operation described in this paper includes elevation of the prolabial skin and reconstruction of the orbicularis oris muscle.     

Treatment of the unilateral cleft lip nasal deformity

The lack of tip projection on the affected side of a unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate structural support. A new technique for the correction of the unilateral cleft lip nasal deformity is described. The key components of the technique involve the use of a dorsally angulated unilateral spreader graft on the cleft side and the use of an L-shaped septal graft to provide support to the cleft nasal tip.     

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.     

Correction of unilateral cleft lip nasal deformity using the sliding sulcus procedure

The nose can be conceptualized as a soft-tissue structure, the orientation of which depends externally on its osseous foundation and internally on the shape and position of its cartilaginous struts. If the soft-tissue envelope of the cleft nose can be given volumetric symmetry, if it can be positioned correctly in space, and if physical forces imposed on it by cleft pathology (i.e., abnormal muscle insertion), then the internal rearrangement or augmentation of the cartilaginous components can await definitive operation later in childhood. The sliding sulcus operation is a subperiosteal procedure designed to address the problems of division, deficiency, displacement, and distortion, taking advantage of its unique ability to mobilize tissues from the maxilla. Surgical techniques are presented with clinical examples.     

Reconstruction of bilateral cleft lip and nose deformity

Bilateral cleft lip and nose deformity can be divided into several types according to the extent of the cleft, protruding premaxilla, size of prolabium and nose deformity. Many repair techniques introduced in the literatures were not perfect because of the change of facial profile under the influence of facial growth.The author uses 1-stage cheiloplasty with nose correction for bilateral cleft lip and nose deformity. Early lip adhesion is used before definitive corrections in wide-cleft patients. The lateral mucosal flaps are used for the lining of alveolar cleft. The lateral orbicularis oris peripheralis flaps with the mucosa approximate in front of premaxilla with creation of a buccal alveolar sulcus and continuity of an orbicularis oris muscle. The lateral orbicularis marginalis muscle flaps with white skin roll and vermillion are used for reconstruction of the Cupid's bow. To enhance the median tubercle, prolabial vermilliomucosal flap is inserted into the gap between an approximated orbicularis peripheralis flap and an approximated orbicularis marginalis flap. Z-plasty of the vestibular ridge and the fixation of lower lateral cartilages to dissect through alar rim excision achieve columella lengthening and tip projection. Lip scar revision is rare, but secondary nose correction using triple V-Y flap is frequent.     

Secondary correction of bilateral cleft lip nose deformity

For correction of the bilateral cleft lip nasal deformity, a modified bilateral reverse U incision is used in combination with a short, forked flap; by using this combination, satisfactory lengthening of the columella, preserving the natural pout of the lip, can be obtained. We have applied this method to 12 cases undergoing secondary repair of bilateral cleft lip in the past 3 years, and the results of this treatment, along with representative photographs of some of our patients, are presented herein.     

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Park等[1]在行二期唇裂鼻畸形整复术时,发现患侧鼻翼软骨有着正常同样的大小和厚度,只是附着和形状发生了异常。基于这一发现,鼻软骨畸形被认为是源于唇裂形成后产生的异常肌肉应力的分布,而不是由于原发的软骨畸形。     

单侧唇裂继发鼻畸形的手术矫正

目的 分析单侧唇裂鼻畸形产生机制,采用相应手术方法对不同年龄患者进行矫正治疗,探讨单侧唇裂鼻畸形手术效果的影响因素.方法 对患侧鼻翼软骨充分松解后与健侧鼻软骨缝合悬吊固定,在同侧鼻前庭黏膜皱褶处采用"Z"成形术,在鼻小柱基部及患侧鼻翼外侧基部的皮下及肌层悬吊固定.纠正鼻翼塌陷、鼻尖过低、鼻小柱偏斜等畸形.结果 56例患者中,鼻翼塌陷矫正满意者占80%,基本满意占18%;鼻尖高度改善满意占78%,基本满意占18%;鼻孔形态对称性及宽度满意占46%,基本满意占44%.总体满意度为94.6%.结论 唇裂继发鼻畸形矫正时对患侧鼻翼软骨的充分松解游离是关键环节,患侧鼻前庭黏膜皱褶不仅影响鼻部形态甚至通气功能,还可能使鼻畸形的表现更显突出,因而对鼻前庭黏膜皱褶的矫正也是十分重要的,尤其在矫正患侧鼻翼塌陷畸形方面有明显辅助作用.     

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双侧唇裂的修复在所有唇裂类型的修复中难度最大,不易得到满意效果,且术后的继发畸形难以矫正。典型的双侧唇裂术后继发畸形包括:鼻小柱过短,鼻尖过宽,鼻外     

Three-dimensional Z-plasty in the correction of the unilateral cleft lip nasal deformity.

OBJECTIVE: Numerous methods have been introduced for correction of the cleft lip nasal deformities, but no single procedure has given sufficiently satisfactory results to provide a surgical standard. Much effort has been put on restoring cartilaginous structures using alar cartilage modification and suspension. But even after the cartilage framework is repositioned well, redundant alar webbing is still unsightly and frequently conspicuous. This paper presents a procedure combining the usual open rhinoplasty technique and three-dimensional Z-plasty in an external approach to remove the alar web and to lengthen the columella at the same time. METHODS: Open rhinoplasty was performed in 26 consecutive patients with unilateral cleft lip nasal deformity from 1991 to 1996. We used an open rhinoplasty approach, which is a combination of the usual infracartilaginous incision on the noncleft side and a small triangular flap on the cleft side. RESULTS AND CONCLUSIONS: This external rhinoplasty incision can provide a wide surgical field for the handling of the whole cartilage framework. The three-dimensional Z-plasty utilizing redundant alar skin not only removes the alar web but also helps lengthen the columella and provides soft tissue to the nasal vestibule. This technique is easy, and the postoperative result is very consistent. Our open rhinoplasty approach has several advantages and can be a useful approach in the correction of the unilateral cleft lip nasal deformity.     

Improved nasal tip projection in the treatment of bilateral cleft nasal deformity

The cleft nose deformity in bilateral cleft lip and palate patients with severely flattened alar cartilages, a short, scarred columella, and thickened skin is a reconstructive challenge. The Wolfe double-arch tip rhinoplasty technique was compared with a cartilage release and tip grafting technique to determine the optimal modality for tip projection and columella lengthening. Patients with significant bilateral cleft nasal deformities and previous bilateral cleft lip repairs were divided into two groups (n = 22). Group 1 (double-arch) patients underwent an open rhinoplasty using conchal cartilage grafts to create a columellar strut and new lower lateral arches placed over the existing arches (n = 12). In group 2 (release and tip graft), the lower lateral cartilages were released, and nasal tip grafting was performed (n = 10). Preoperative and 6-month postoperative measurements, including (1) columellar length, (2) alar base-nasal tip-columellar base (ATC) angle, and (3) lateral tip projection, were compared. The lateral tip projection is the perpendicular distance between the nasal tip and a line created from the connection of points at the nasion to the subnasale. In group 1 (double arch), the mean columella length increased 47.2%, whereas in group 2 (release and tip graft), it only increased 14.1%. The ATC angle had a mean decrease or narrowing of 26.7 degrees in group 1, compared with a 12.5 degrees decrease in group 2. Lateral tip projection improvement was greater in group 1 (52.2% increase) compared with group 2 (19.9% increase). The authors' data showed that for the difficult bilateral cleft nasal deformity with significant tip flattening, the double-arch tip rhinoplasty provides improved nasal tip projection.     

应用鼻翼基部内侧组织瓣修复单侧完全性唇裂

目的 探讨利用鼻翼基部内侧组织瓣修复单侧完全性宽唇裂的方法。方法 选择单侧完全性唇裂78例,手术时确保健患侧唇边长相等,利用患侧鼻翼基部内侧组织瓣增加患侧唇高,使健患侧的唇高对称。其余操作同“Millard”术式。结果 66例术后健、患侧上唇对称,唇高及唇边长两侧相等,瘢痕不明显。唇珠形态好。术后1．5年复诊,84．6％效果比较理想;10例术后效果一般;2例需Ⅱ期修复。结论 对于较宽的单侧完全性唇裂,利用翼基部内侧组织瓣代偿组织缺损。是又一种行之有效的修复方法。     

Application of nasal clip in the one-stage repair of unilateral cleft lip nasal deformity

目的 探讨鼻夹在单侧唇裂鼻畸形一期整复术后的应用效果。方法 选取2017年1月—2018年6月在四川大学华西口腔医院唇腭裂外科行单侧唇裂鼻畸形一期整复术的患者60例,分为鼻夹组、鼻模组和对照组。3组患者均在术后6~12个月复诊,并对鼻外形进行评价。结果 鼻夹组患者的鼻外形发育及美学效果较对照组有明显改善,差异有统计学意义（P<0.05）。结论 鼻夹对于唇裂鼻畸形患者矫正术后鼻外形的改善有良好的效果,而且鼻夹操作简单,患者依从性较好,值得临床推广使用。     

化妆技术用于唇裂术后患者唇畸形修饰的效果探讨

目的 探讨化妆技术用于唇裂术后患者唇畸形修饰的效果。方法 选择35例唇裂术后鼻唇畸形需行唇裂二期修复手术的患者,术前运用化妆技术进行唇部畸形修饰,分别在化妆前和化妆后为患者拍摄正面照片,由患者及医务人员分别观察照片,采用Visual Analogue法（患者）和Asher-McDade、Mortier PB量表（医务人员）对化妆前后的唇部外形进行外观评价,比较化妆前后的改善情况。结果 化妆前,患者的自我评价分数为（56±13）分,医务人员的评价分数为（3.22±1.11）分,化妆后患者评分为（67±12）分,医务人员评分为（2.85±1.03）分,化妆前后的差异均有统计学意义（P<0.05）。结论 合理有效地运用化妆技术,可以在一定程度上修饰唇裂术后患者唇部的相关畸形。化妆修饰在恢复唇峰对称性、唇弓连续性以及凸显人中嵴等方面具有明显的效果。     

Simultaneous reconstruction of columella and philtrum using prolabial flap combined with Abbe flap in secondary bilateral cleft lip and nasal deformity

Open rhinoplasty and Abbe flap techniques are traditionally useful tools for the reconstruction of secondary bilateral cleft lip nasal (BCLN) deformity. We aimed to investigate the long-term outcomes of simultaneous columella and philtrum reconstruction using prolabial flap combined with Abbe flap in secondary BCLN deformity.From January 2009 to July 2014, 26 patients (17 males and 9 females; mean age 21 years) with secondary BCLN deformity were recruited. All patients had severe short columella and philtrum deficiency. The whole superiorly based prolabial flap was harvested and trimmed for columella reconstruction. An Abbe flap from the central lower lip was elevated to reconstruct the esthetic philtral unit. No flap necrosis occurred postoperatively. The average follow-up was 2.7 years. The columella length was 4.7 ± 1.3 mm preoperatively and 10.4 ± 2.1 mm postoperatively. The philtrum length increased to 14.4 ± 2.6 mm postoperatively from a preoperative 8.9 ± 2.4 mm. Regarding the overall impression of the reconstruction, 22 patients ranked it as very good or good.In secondary BCLN deformity, the prolabial flap combined with Abbe flap technique is an effective alternative for the treatment of severe short columella complicated with severe philtrum deficiency.