唇腭裂术后反合患者口周肌肌电图的研究

通过对２８名正常、２７名普通反殆及２９名单侧完全性唇腭裂术后反患者的上唇肌及颏肌肌电图的检查，发现唇腭裂术后反患者口周肌肉存在特征性的肌电活动：①患者吞咽唾液时，上唇及颏肌肌电幅显著大于正常及普通反组；②唇腭裂组及普通反组患者姿势位时，颏肌肌电幅大于正常；③患者在各功能位时，上唇肌肌电活动非对称指数大于正常及普通反患者。唇腭裂术后反患者口周肌肉活动的异常，提示临床医师进行唇裂功能性修复的必要性，对于过紧修复的唇，应适时配戴唇挡。     

改进口轮匝肌重建技术对单侧完全性唇裂唇鼻前突度的影响

目的 提出并验证一种新的口轮匝肌重建技术,提高单侧完全性唇裂修复术后唇鼻前突度.方法 口轮匝肌重建新技术为裂隙侧口轮匝肌上端缝合固定于前鼻棘、下份与对侧口轮匝肌游离端缝合.纳入63例常规口轮匝肌重建技术修复的单侧完全性唇裂患者(常规组),20例改进口轮匝肌重建技术修复的单侧完全性唇裂患者(改进组))及96例不完全性腭裂患者(对照组).制取唇裂术前、术后即刻及腭裂术前面部石膏模型,运用石膏模型三维分析技术分析各组唇鼻形态之间的差异.结果 唇裂术后即刻改进组几乎所有唇鼻标志点(SA点除外)的前突度均大于常规组(P<0.05).与对照组相比,唇裂术后即刻,改进组裂隙侧上唇前突度完全恢复正常,而鼻翼甚至存在一定程度的过矫正.腭裂修复术前,改进组裂隙侧上唇前突度略低于正常,而过矫正的鼻翼前突度减小至正常.结论 改进口轮匝肌重建技术能显著提高单侧完全性唇裂修复术后的唇鼻前突度.     

双侧唇裂修复手术方法的改进

双侧唇裂修复手术方法的改进曲延刚，张玉根，李艳军，张庆元双侧唇裂常采用Ｂｒｏｗｎ和Ｂａｒｓｋｙ术式，由于前唇组织缺损多、移位大、前颌高突，故修复后唇部解剖形态，生理功能难以恢复，尤其人中凹、唇珠形态不明显。口轮匝肌未重建其连续性，是造成唇部运动平坦畸...     

口轮匝肌功能重建修复单侧完全性唇裂

目的 探讨口轮匝肌功能重建在单侧完全性唇裂修复术中的应用及效果评价。方法 回顾分析2007年—2011年我科收治的82例单侧完全性唇裂患者,其中52例唇裂整复术中同期行口轮匝肌功能重建术,而30例仅行单纯唇裂整复术。2组患者均随访6个月,测量比较2种治疗方法整复后的患者术后鼻唇外形。结果 在唇裂整复术同期应用口轮匝肌功能重建组的患者,术后可获得更好鼻唇对称性,患侧上唇高度及鼻孔高度明显优于未行口轮匝肌重建组（P<0.01）,并可获得满意的人中、鼻堤、红唇形态。结论 单侧完全性唇裂整复术中同期施行口轮匝肌功能重建能有效地恢复口轮匝肌连续性及其生理功能,有助于提高单侧完全性唇裂的治疗效果。     

改良Millard''s功能性修复双侧唇裂

目的 探讨双侧唇裂的功能性修复方法。方法 应用改良Millard‘s法通过增加环鼻翼外侧脚切口，使鼻翼外侧脚更易复位，矫正了口轮匝肌的异常附着，一期重建口轮匝肌环，对于前唇过于短小者则借鉴Barsky‘s法延长前唇。应用该方法修复双侧唇裂24例，年龄最小6月，最大12岁。结果 多数患者获得了满意的修复效果，仅1例伤口部分裂开。结论 应用该方法修复双侧唇裂有较高的临床应用价值。     

安氏Ⅱ类1分类错口周肌肌电活动的研究

目的对比研究恒牙列早期安氏Ⅱ类1分类错畸形,矫治前口周肌(上口轮匝肌、下口轮匝肌、颏肌)在不同功能状态下的肌电活动变化。方法选择20例恒牙列早期安氏Ⅱ类1分类错畸形患者,采用表面肌电仪对矫治前口周肌在下颌息止位、唇闭合、咬合、吞咽等不同功能状态下的肌电活动变化进行检测。通过计算机辅助软件与个别正常对照组进行肌电幅值的定量分析比较,并与相关颅面、牙头影测量参数进行多元回归分析。结果下颌息止位与咬合时,安氏Ⅱ类1分类错与个别正常对照组相比,口周肌肌电活动在统计学上均没有显著性差异;唇闭合时,安氏Ⅱ类1分类错组上口轮匝肌和颏肌的肌电活动幅值明显高于个别正常对照组;吞咽时,安氏Ⅱ类1分类错组口周肌肌电活动幅值均高于个别正常对照组,在统计学上具有显著性差异。结论安氏Ⅱ类1分类错上下颌骨矢状关系的不调以及上下切牙的唇向倾斜和前突,与功能活动中口周肌肌电活动的异常增高密切相关,是影响唇功能异常的重要因素。     

改良直线缝合法功能性修复重度双侧唇裂

目的:探讨应用改良直线缝合法功能性修复重度双侧唇裂的方法和临床效果.方法:在直线缝合法基础上通过设计侧唇的红唇黏膜肌瓣,旋转于前唇下方修复前唇唇红及唇珠;在前唇瓣侧方设计蒂在鼻中隔方向的近三角形皮瓣（C瓣）,在鼻前庭底部设计皮瓣（G瓣）同时,在鼻底裂隙两侧设计鼻黏膜瓣（D瓣和H瓣）,以封闭鼻底;离断口轮匝肌的异常附着,重建口轮匝肌的连续性. 结果:术后患者上唇及唇红丰满,动态畸形不明显,鼻底封闭良好.结论:此法修复重度双侧唇裂可获得较好的上唇形态,减少“口哨”畸形﹑口鼻瘘及术后动态畸形的发生.     

安氏Ⅱ类1分类错(牙合)口周肌肌电活动的研究

目的 对比研究恒牙列早期安氏Ⅱ类1分类错牙合畸形,矫治前口周肌(上口轮匝肌、下口轮匝肌、颏肌)在不同功能状态下的肌电活动变化.方法 选择20例恒牙列早期安氏Ⅱ类1分类错牙合畸形患者,采用表面肌电仪对矫治前口周肌在下颌息止位、唇闭合、咬合、吞咽等不同功能状态下的肌电活动变化进行检测.通过计算机辅助软件与个别正常牙合对照组进行肌电幅值的定量分析比较,并与相关颅面、牙牙合头影测量参数进行多元回归分析.结果 下颌息止位与咬合时,安氏Ⅱ类1分类错牙合与个别正常牙合对照组相比,口周肌肌电活动在统计学上均没有显著性差异;唇闭合时,安氏Ⅱ类1分类错牙合组上口轮匝肌和颏肌的肌电活动幅值明显高于个别正常牙合对照组;吞咽时,安氏Ⅱ类1分类错牙合组口周肌肌电活动幅值均高于个别正常牙合对照组,在统计学上具有显著性差异.结论 安氏Ⅱ类1分类错牙合上下颌骨矢状关系的不调以及上下切牙的唇向倾斜和前突,与功能活动中口周肌肌电活动的异常增高密切相关,是影响唇功能异常的重要因素.     

磨牙症患者咀嚼肌肌电特征的研究

目的探讨磨牙症对咀嚼肌功能的影响以及咀嚼肌受损的肌电表现。方法收集24例磨牙症患者和16例无磨牙症学生分别作为磨牙症组和正常组。用Bio PAK口颌功能诊疗系统测量双侧颞肌前束（TA）、咬肌（MM）、二腹肌前腹（DA）和胸锁乳突肌（SCM）在姿势位、牙尖交错位（ICP）最大紧咬和吞咽时的表面肌电活性。结果磨牙症组姿势位时TA和MM的肌电幅值明显高于正常组,而ICP最大紧咬时TA和MM的肌电幅值明显低于正常组,以上差异均有统计学意义（P<0.05）;吞咽时2组各肌肉的肌电幅值没有明显差别。磨牙症组ICP最大紧咬时TA和MM的不对称指数与正常组无统计学差异（P>0.05）。结论磨牙症患者的咀嚼肌功能紊乱主要表现为颞肌前束和咬肌在姿势位呈高电位,而在ICP最大紧咬时呈低电位。     

21例单侧唇裂功能性修复术的临床分析

２１例单侧唇裂功能性修复术的临床分析江苏省人民医院口腔科许扬江苏省人民医院整形科蔡耿秋自国外学者Ｋｅｎａｈａｎ、Ｎｉｃｏｌａｕ对唇肌，尤其是口轮匝肌的正常解剖、唇裂患者口轮匝肌异常发育和错位畸形作了深入的研究以来，在此基础上提出了与以往唇裂修复术迥然...     

66例双侧唇裂功能性整复的临床疗效观察

目的 探讨改良Mulliken法功能性修复双侧唇裂的临床效果。方法 选取66例双侧唇裂患者,应用改良Mulliken法进行唇裂整复,术中在前唇设计窄的“领带”型人中结构;解剖复位侧唇口轮匝肌,重建口轮匝肌环;利用侧唇唇红组织重建唇珠。同期初步矫正鼻畸形,延长鼻小柱。结果 术后经0.5~2 a随访,所有患者无“三等份上唇”不良外观,超过80%（54/66）的患者上唇唇弓形态恢复自然,左右对称,人中宽度与正常相似。唇红丰满,唇珠大小适度,无口哨畸形,动静态外形良好。鼻底宽度正常、鼻孔形态对称,鼻小柱高度较术前延长,鼻尖形态基本满意。结论 利用改良Mulliken法功能性修复双侧唇裂,能有效纠正鼻唇畸形,临床效果良好,值得推广使用。     

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.     

Nasal deformity and microform cleft lip in parents of patients with cleft lip.

OBJECTIVE: To describe subtle nasal deformities and microform cleft lips in parents whose children have complete cleft lip deformities. DESIGN: Clinical analyses of three parents whose children had complete cleft lips. Subtle nasal deformities and microform cleft lips were identified. SETTING: An institutional general hospital: Manuel Gea González Cleft Lip and Palate Clinic in Mexico City, Mexico. PATIENTS: The study first examined the parents of all complete and incomplete cleft lip-palate patients who were seen from March 1994 to February 1997 by the authors (n = 1000). We identified three patients, each of whom had one parent who showed signs of subtle nasal deformity and microform cleft lip. INTERVENTIONS: None for the parents. Interventions in the children with cleft lips and palates were known. MAIN OUTCOME MEASURES: Qualitative photographic analyses were performed. Nostril symmetry, septal deviation, nasal floor position, and orbicularis oris malinsertions were carefully examined. RESULTS: Three of the evaluated parents had one alar cartilage caudally displaced and a deviated septum. One parent's nasal floor was depressed. Two parents also had evidence of a minimal orbicularis oris muscle fissure located in the upper lip. CONCLUSION: Genetic evaluations of children with complete and incomplete cleft lips might also include thorough evaluation of their parents. Although small in size, this study of three case histories identified nasal and lip deformities in the patients' parents.     

Arrangement of the orbicularis oris muscle in different types of cleft lips

A thorough knowledge of the anatomy of the labial region, especially the arrangement of the muscle fibers, is essential for the success of primary repair of the cleft lip. Pared lateral and medial edges from 20 unilateral incomplete cleft lips and 25 unilateral complete cleft lips were obtained during primary surgery. Three specimens of normal lips were taken from unclaimed infant cadavers as the controls. They were prepared for routine histological studies and were examined to study the direction of muscle fibers. Intrinsic and extrinsic bundles were identified in both lateral and medial sides of specimens of both cleft types. The intrinsic bundle was not displaced but was interrupted by the cleft. The extrinsic bundle in the lateral side of both cleft types ran upward along the lateral cleft margin, whereas in the medial side it ran horizontally to terminate close to the medial cleft margin. The extrinsic bundle is the retractor, which is associated with facial expression, whereas the intrinsic bundle is the constrictor of the mouth. Because there are two functional components in the orbicularis oris muscle, identifying and repairing them separately will enable each of them to accomplish their distinctive functions.     

唇裂术中口轮匝肌的解剖学修复

目的：探索唇裂患者口轮匝肌解剖学修复的方法。方法：解剖分离患侧口轮匝肌深怪、浅层的鼻唇不及鼻束。深层及浅层鼻唇束与健侧相应仙束缝合。鼻束与位与鼻小柱下方鼻唇束形成的旋转的肌瓣缝合。结果：对10例唇裂患者进行口轮匝肌的解剖学修复，术后切口瘢痕较小。动态及静态上唇形态满意。结论：口轮匝肌的解剖学修复有利于唇裂患者动态及静态的形态修复。     

Functional reconstruction of the philtral ridge and dimple in the repaired cleft lip

Our report describes a simple method of functional reconstruction of the philtral ridge in patients with repaired cleft lip. Philtral reconstruction was performed in 21 children with dehiscence of the orbicularis oris in repaired cleft lip. Prominent groove at the philtral column and lateral bulging during maximal "pucker" were the indications. First, the abnormally inserted orbicularis muscle is freed and realigned in a normal horizontal orientation. The muscle is vertically incised and repaired with vertical mattress sutures, spreading out the muscle to increase the thickness of the philtral ridge. The philtral ridge is accentuated by deepening the dimple with a dermal suture at the midline. Postoperative evaluation was performed at 8-18 months (mean; 13.1 months). The philtrum was evaluated by a panel using two visual scales. Eminence of the philtral ridge was scored by a five-point grading scale and the philtral dimple was scored by a three-point grading scale, both at resting and at maximal pucker. Preoperative scores showed the philtral ridge to be from "prominent groove" to "flat" at maximal pucker and at rest, respectively. Postoperative scores showed improvement of the philtral ridge to "less prominent than the normal philtral ridge" both at rest and at maximal pucker. The philtral dimple preoperative scores ranged from "no dimple" to "slight dimple" and postoperative improvement to "slight dimple" to "prominent dimple." This technique of functional reconstruction of the philtrum gave satisfactory results in formation of the philtral ridge and dimple, both at rest and at maximal pucker.     

EMG activity of the orbicularis oris and mentalis muscles in children with malocclusion, incompetent lips and atypical swallowing Part I

The function and the level of activity of the orbicularis oris (upper and lower), and of the mentalis muscles were verified electromyographically in resting position and in several movements and carried out in 18 children aged 812 years, divided into three groups: one with normal occlusion, and two with Class II division 1, with atypical swallowing and/or incompetent lips, who had received no orthodontic treatment. It was observed that, in a resting position with the lips separated, there was no activity in any of the muscles. When there was a contact of the lips, action potentials were recorded in the muscles studied, in those individuals with incompetent lips. In the movements of sucking either through a straw or a pacifier and the thumb, there were no differences among the groups. The incompetent lips group presented very marked muscle activity of the lower orbicularis oris and mentalis in the movement of sucking a lollipop. In deglutition of saliva, the orbicularis oris presented slight activity, and the mentalis, moderate. In deglutition of water, the mentalis presented very marked activity, whereas, the upper and lower orbicularis oris presented moderate and marked activities, respectively.     

Philtrum reconstruction in unilateral cleft lip repair

The philtrum is an important aesthetic structure in the midface. A number of philtrum reconstruction techniques have been advocated for secondary cleft lip revision procedures. Conventional surgical management involves end-to-end orbicularis oris muscle approximation during primary cleft lip repair, often resulting in a flat lip appearance that requires secondary revision surgery at a later stage. A novel modification of the approximation of the orbicularis oris muscle is described that may be implemented with any cleft lip technique in order to create an accentuated philtrum column for a natural looking philtrum. The muscle roll technique results in eversion of the orbicularis oris muscle, successfully recapturing the philtrum column topography. This is achieved by utilizing two inverted horizontal sutures, with an additional philtrum takedown suture placed in the region of the dimple to accentuate the philtrum anatomy and three-dimensional profile. This novel technique in unilateral cleft lip repair addresses philtrum architecture during primary surgery, which may reduce the requirement for secondary surgical intervention. Its application may be particularly suitable in outreach programmes where postoperative follow-up may be compromised.     

Anatomical basis for apparent subepithelial cleft lip: a histological and ultrasonographic survey of the orbicularis oris muscle

Objective: To determine if there is an anatomic basis for subepithelial orbicularis oris muscle defects by directly comparing ultrasonographic images of the upper lip with corresponding histological sections obtained from cadavers. Methods: Ultrasound was performed on the upper lips of previously frozen, unpreserved cadaver heads (n = 32), followed by dissection and sectioning of the upper lips. The ultrasound sequences were scored by a panel of raters, classifying the orbicularis oris muscle as negative, positive, or unknown for the presence of an orbicularis oris discontinuity (subepithelial defect). Based on ultrasound, six lip specimens were chosen for histological sectioning, were stained with hematoxylin-eosin and Gomori trichrome stain, and were evaluated with light microscopy at low (8x) and intermediate (100x) magnification. Results: One cadaver was scored positive for an orbicularis oris muscle discontinuity based on ultrasound; whereas, the remaining cadavers were scored negative. Of the cadavers with negative ultrasound scores, two were noted to have orbicularis oris muscles with "irregular" features (e.g., excessive localized thinning or asymmetry). From histology, the area of discontinuity as visualized on the positively scored ultrasound was characterized by both disorganized orbicularis oris muscle fibers and excess connective tissue within the muscle belly. In contrast, the localized thinning observed on some of the negatively scored ultrasounds was not confirmed by histology. Conclusions: Abnormalities of the orbicularis oris muscle visualized by ultrasound have an anatomic basis as revealed through histology. Ultrasound is a useful tool for noninvasively identifying discontinuities of the orbicularis oris muscle.