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.     

黏膜瓣Z成形术矫正二期单侧唇裂鼻翼畸形

目的评估运用黏膜瓣Z成形术矫正鼻翼塌陷的治疗效果。方法 2011年12月至2013年6月,对46例二期单侧唇裂患者使用黏膜瓣Z成形术锁边,缝合大翼软骨和侧鼻软骨来矫正其鼻翼畸形。测量鼻小柱倾斜度和鼻孔宽度,并进行统计分析。结果患侧鼻孔的宽度、鼻小柱的倾斜度及鼻尖和鼻翼的对称性都有明显改善。41例患者术后随访6个月,3例患者出现了轻度复发,但其数据分析与术前比较仍有明显改善。结论黏膜瓣Z成形术可有效矫正单侧唇裂患者的鼻翼塌陷。     

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.     

Nostrilplasty: Raising,lowering, widening,and symmetry correction of the alar rim

Background: Although the alar rim has frequently been neglected in correction of nasal deformities, techniques for its improvement have been proposed and used successfully. Objective: Two techniques for correction of the deformed alar rim are described. Methods: To lower the alar rim, the internal skin of the vestibule is dissected away from the areolar tissue and brought down as a flap. A segment of cartilage is taken from the septum or upper portion of the lower lateral cartilage. The cartilage graft is placed in the rim and the vestibular mucosa is folded over the graft and sutured to hold the cartilage in place. Raising of the alar rim is accomplished through direct excision to raise the rim and to make the nostril longer or wider. This technique is applicable to correction of a dropped rim, pinched nostrils, hidden columella, sigmoid ala, small nostrils, and foreshortened nose. Results: These techniques have been used to treat primary, secondary, and traumatic nasal deformities in more than 200 patients during the past 20 years with few complications. Conclusions: Although the techniques described require a learning curve, once mastered they can be combined with other techniques used routinely in rhinoplasty to successfully treat a variety of nasal deformities. (Aesthetic Surg J 2002;22:227-237.)     

单侧唇裂术后继发鼻孔过小的整复术

目的探讨矫正唇裂术后继发鼻孔过小畸形的更有效方法。方法将患侧上唇较之对侧不对称的“多余”组织形成局部皮瓣,用于扩大鼻孔,同时调整鼻翼位置。结果8例患者用此种方法修复术后,在两侧鼻翼、鼻孔、鼻槛等方面基本对称,取得满意效果。结论患侧上唇皮瓣加鼻翼复位是一种有效矫正唇裂术后鼻孔过小畸形的方法。     

髂骨片移植辅助鼻翼软骨悬吊矫正唇裂鼻畸形

目的探讨一种矫正单侧唇裂继发鼻畸形的有效、可靠方法。方法对61例单侧唇裂鼻畸形患者,采用患侧鼻翼外侧脚基底部颌骨骨膜下皮质骨片贴敷移植,鼻翼软骨内侧脚间植入髂骨皮质骨片,依健侧鼻孔形态,选择鼻翼软骨截断部位和悬吊方式,重建鼻翼软骨肌肉环,术后保持3个月。结果本组61例患者随访3～24个月,56例效果稳定,5例术后出现轻度复发。结论单侧唇裂继发鼻畸形成因复杂,通过颌骨、鼻翼软骨、鼻唇肌肉组织的综合矫治,可有效地改善畸形;稳定牢固地悬吊可增强疗效稳定性、减少畸形的复发率。     

唇裂术后继发畸形的功能性修复

目的：探讨唇裂术后继发鼻唇畸形功能性修复的美容效果。方法：主要针对鼻翼畸形、鼻孔不对称等进行手术，分离鼻翼软骨并抬高内侧脚，缩小鼻孔基底，纠正鼻翼塌陷畸形。结果：1998年以来，共收治32例患者，随访1～4年，效果满意。结论：充分游离鼻翼软骨并使其复位到与对侧对称，消除了鼻畸形的病理基础，从而保证了畸形修复的远期效果。     

Correcting the residual cleft lip nasal deformity using a nasal dorsum autograft: personal experience

. The method proposed is intended to reinforce the columellar support while simultaneously correcting the nasal tip and ala and improving the nostril symmetry in patients with secondary nasal deformities following cleft lip and palate surgery. It is based on using a bone cartilage autograft – a fragment that is taken from nasal dorsum and implanted into the nasal tip region. Very good aesthetic and functional postoperative results were reported in all 33 patients operated on so far (28 with unilateral and five with bilateral cleft lips).     

Composite earlobe grafts to reconstruct the lateral nasal ala and sill

Numerous operations have been described to address the unilateral cleft lip deformity. One area that has not received significant attention is the deficient join between the nasal ala and the upper lip. Several surgeons have advocated detaching the ala and rotating it medially to restore the nasal sill and decrease the alar flare. Unfortunately, many children with clefts do not have enough available tissue to perform these maneuvers without compromising the nostril opening. In this article, the authors present a technique using composite earlobe grafts with sandwiched cartilage grafts to restore symmetry with the contralateral nostril. This technique has also been used in adult patients undergoing reconstruction because of cancer ablation or traumatic injuries. All patients received adjuvant hyperbaric oxygen therapy.     

Correction of the nose in patients with unilateral cleft lip with composite grafts.

We used composite conchal cartilage graft for columellar lengthening in eight patients with unilateral cleft lip and a nasal deformity. In 16 patients we used a buccal mucosal graft to line the nasal vestibule. We also used corrective procedures such as alveolar bone grafting for closure of palatal fistulas, septoplasty, malar augmentation, nasal osteotomy, and Le Fort I osteotomy to deal with associated deformities. Grafts took well with no loss and no donor site morbidity. In the follow up of 8 months-3 years, corrections were found to be stable and satisfying to all the patients. Only by replacing deficient tissues with similar tissues and putting them in the proper anatomical position can long term consistent and reliable results be achieved in the correction of nasal deformities associated with unilateral cleft lip.     

单侧唇裂继发鼻畸形的修复

目的 通过分析单侧唇裂鼻畸形成因、病理解剖改变,探索修复单侧唇裂继发鼻畸形有效可靠的方法.方法 57例单侧唇裂继发鼻畸形患者,采用颌骨裂隙植骨,鼻翼软骨两内侧脚间植入髂骨皮质骨片,依健侧鼻孔形态,选择鼻翼软骨截断部位和悬吊方式,重建鼻翼软骨肌肉环,术后用管状支撑物插入鼻孔保持3个月.结果 术后将鼻翼塌陷、鼻尖、鼻孔、鼻小柱与术前对比评价,满意率为93%（53例）.术后随访3～24个月,52例疗效稳定,5例出现轻度复发.结论 单侧唇裂继发鼻畸形成因复杂,通过颌骨、鼻翼软骨、鼻唇肌肉组织的综合矫治,可有效地改善畸形.并通过稳定牢固的悬吊和恢复肌力的平衡,增强疗效的稳定性,可有效地改善畸形.     

A new technique for perioral muscle reconstruction and lip lengthening in complete unilateral cleft lip

BackgroundAdequate skin lengthening and symmetry may not be consistently obtained in unilateral cleft lip repair, especially in patients with complete cleft. The purpose of this study was to present the model of muscle dissection and approximation to facilitate lip lengthening and symmetry.MethodsThe design followed the rotation-advancement (RA) method without skin measurement. A curvilinear skin incision was made from subnasale to the Cupid's bow peak (CBP). Muscle dissection was continued to the contralateral nostril floor beneath the columellar base to facilitate downward rotation in the medial lip. Wide muscle dissection was performed in the lateral lip segment from the nasal mucosa passing the alar base. The lateral lip muscle was advanced and sutured to the medial lip muscle in a Z-plasty fashion. A small skin backcut was made above the CBP. Primary nasal correction was performed. A series of 138 patients with complete unilateral cleft lip and palate were included in this study. Standard photographs were collected for measurement in the nasolabial region.ResultsAdequate lengthening and symmetry of the lip was obtained. The ratio of vertical philtral height was 0.99±0.05 between the cleft and noncleft sides. The C flap was used for supplementary skin lengthening in 58% of cases. Postoperative lip retraction requiring massage occurred in 13%. Overall nasolabial appearance was satisfactory.ConclusionThe new technique of perioral muscle reconstruction facilitated to obtain lip lengthening and symmetry in the repair of complete unilateral cleft lip.     

Millard Ⅱ式手术矫正单侧唇裂术后继发畸形的分析

目的 分析Millard Ⅱ式手术矫正单侧唇裂术后继发唇鼻畸形的优点与手术要点.方法 2003年3月至2004年9月,对42例单侧唇裂术后继发畸形患者采用Millard Ⅱ式手术矫正,同时松解患侧鼻翼软骨与皮肤的粘连,应用埋没导引针悬吊鼻翼软骨,或切断其内侧脚后上提与对侧鼻翼软骨内侧脚缝合.结果 所有患者术后切口愈合良好.随访3～6个月,患侧鼻小柱延长,两侧鼻孔对称,人中嵴对称,唇弓形态好,无瘢痕增生.结论 Millard Ⅱ式手术是矫正单侧唇裂术后继发畸形的理想术式,同时松解、悬吊患侧鼻翼软骨能够更好地矫正鼻畸形.     

鼻表浅肌肉腱膜瓣在特殊鼻畸形整复中的应用

目的:探索特殊鼻畸形的有效整形修复方法.方法:对34例鼻畸形,其中先天性鼻窦道13例,先天性鼻眶裂2例,先天性鼻裂7例,双侧唇裂继发鼻畸形12例,应用鼻表浅肌肉腱膜瓣修复.结果:本组病例术后双侧鼻翼及双侧鼻孔均对称,鼻表情运动和鼻孔舒缩功能恢复.平均随访9个月,均效果满意.结论:应用鼻表浅肌肉腱膜瓣修复特殊鼻畸形是一种安全有效的方法.     

鼻尖双峰皮瓣矫正单侧唇裂术后继发鼻畸形

目的 探讨鼻尖双峰皮瓣矫正单侧唇裂术后继发鼻孔狭小畸形的有效方法.方法 采用鼻部飞鸟形切口,将鼻尖部皮瓣逆行切开,形成双峰皮瓣,用于矫正唇裂术后继发鼻畸形.结果 2005至2009年为28例患者采用上述方法修复后,双侧鼻翼、鼻孔大小、鼻小柱的长度及位置、鼻尖的高度及鼻门槛等基本对称,满意率为93%(26/28),2例因仰鼻术后鼻尖形态不佳,经加高处理后改善.21例术后获6～12个月随访,效果良好,无复发,维持术后形态.结论 鼻尖双峰皮瓣是矫正唇裂术后继发鼻畸形,尤其是鼻孔中、轻度狭小畸形的较理想方法.

Abstract：

Objective To investigate an effective method for the correction of the narrow nostril secondary to cleft lip. Methods A"bird wing shape" incision was made on the nasal tip to form a"W- shape" flap for repairing the nasal deformities secondary to cleft lip, especially for the cases with narrow nostril. Results Twenty-eight patients were treated with this method. All the cases achieved a symmetry shape of nasal ala, nostril, nasal columella and a normal height of nasal tip except for 2 cases with malformation at nasal tip who achieved improvement after reoperation. 21 cases were followed up for 6-12 months with good cosmetic result and no recurrence. Conclusions "W-shape" flap at the nasal tip is an ideal way for the correction of mild to moderate narrow nostril deformity secondary to cleft lip.     

应用改良Bardach法矫正单侧唇裂术后鼻畸形

单侧唇裂修复后鼻畸形的矫正较为棘手,采用改良的 Bardach 法对29例进行矫正手术并获得比较满意的效果。认为手术成功的关键在于延长患侧鼻小柱和将移位的鼻翼软骨充分游离修整复位以形成端正的鼻尖。文内详细叙述了手术方法,术中注意事项,并对鼻畸形手术矫正的术前应考虑到的一些问题和改良 Bardach 法的特点进行了讨论和评价。     

应用改良Bardach法矫正单侧唇裂术后鼻畸形

单侧唇裂修复后鼻畸形的矫正较为棘手，采用改良的Ｂａｒｄａｃｈ法对２９例进行矫正手术并获得比较满意的效果。认为手术成功的关键在于延长患侧鼻小柱和将移位的鼻翼软骨充分游离修整复位以形成端正的鼻尖。文内详细叙述了手术方法，术中注意事项，并对鼻畸形手术矫正的术前应考虑到的一些问题和改良Ｂａｒｄａｃｈ法的特点进行了讨论和评价。     

Lengthening of the short columella associated with bilateral cleft lip.

Operations for lengthening the columella can be classified into three groups on the basis of source of material: lip, nose, or ear. When seen in profile, the middle of the lip provides one-fourth to one-third of the forward projection of the columella as compared with the level of the alar bases. Complete bilateral cleft lips usually benefit from columellar lengthening, but symmetrical, incomplete clefts rarely require it. Ancillary procedures, such as correction of a retruded maxilla by Le Fort I osteotomy or by contour build-up, can enhance the overall result. Our experience with advancement of skin from the floor of the nose and ala [15], skin from the alar margins at the tip [7], prolabial advancement flaps, fork flaps, and composite earlobe grafts is reported.     

单侧唇裂修复同期鼻畸形矫正术

目的 探讨在修复伴有鼻畸形的先天性唇裂时,同期一次性矫正鼻部畸形,以最大程度地减少唇裂术后继发性鼻畸形发生的手术方法.方法 采用Millard术式或Millard术式＋三角瓣插入法,同时利用唇裂手术切口入路恢复大翼软骨、鼻肌及鼻小柱的正常解剖位置以矫正鼻畸形.结果 共修复单侧唇裂108例,术后随访1个月至3年,效果满意.结论 所有单侧唇裂均伴发鼻畸形,在唇裂修复同期进行鼻畸形的矫正,可获得即刻的手术效果和较为满意的远期疗效,并可能减少再次手术及手术难度.     

单侧完全性唇裂术后继发鼻唇畸形的一次性修复

目的：介绍一种综合术式一次性整体矫正单侧完全性唇裂术后继发鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定，以缩窄以平齐鼻底；穹隆MT瓣成形术改善鼻孔形状；带侧翼鼻假体隆鼻突出鼻部立体感和加高鼻翼；上唇M瓣成形修整唇红缘重建唇弓；双侧口角为蒂的唇黏膜瓣或下唇瓦合式黏膜瓣修复上唇唇红过薄、过短或部分缺损。结果：单侧完全性唇裂术后继发鼻唇畸形21例，随访10例3个月至1年，外观和效果满意。结论：应用一针法鼻小柱鼻翼脚复位加MT成形术和双蒂唇黏膜瓣移植等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。