Modification of Reichert's technique based on natural landmarks and individual designs for unilateral repair of cleft lip

We present a new technique for repair of unilateral cleft lip used in 230 patients. This is a modification of Reichert's technique for unilateral cleft lip repair. It is based in three concepts: form, severity, and natural landmarks of the lip. All the incisions are placed on natural landmarks, between the aesthetic subunits of the upper lip. The incision for rotation of the philtrum is designed to imitate the column of the philtrum on the normal side with good aesthetic result. We do not use a subnasal incision on the lateral side. Since 1996, we have used this technique in 230 unilateral cleft lip repairs. We obtained a good functional and aesthetic result in the nose and upper lip. Our failure rate was 14%. We describe Reichert's modified technique, named the Reichert-Millard's technique, with good aesthetic results (fewer scars and more individual designs than traditional techniques) for repair of the lip and nose in patients with unilateral cleft lip.     

单侧微小型唇裂的个体化修复术

目的探讨单侧微小型唇裂整复术的个体化设计以及人中嵴形态的整复方法。方法在尽可能保留裂隙侧未受累区皮肤的前提下，对9例单侧微小型唇裂患儿采用个体化设计。对于两侧唇峰高度差值小于2n姗的病例，采用局部Rose切口；两侧唇峰高度差值大于2n姗的病例，在裂隙远中侧唇红缘上方皮肤形成底边长度为差值2／3的等腰三角瓣，再用局部倒V型切口消除皮肤猫耳。同时，唇红部形成交叉三角瓣消除唇红切迹。从皮肤切口入路潜行分离口轮匝肌至鼻底，矢状面切断口轮匝肌薄弱处后再从裂隙远中侧肌肉断面作冠状面剖开，交叉重叠口轮匝肌增加入中嵴区肌层厚度；插入皮肤和唇红三角瓣恢复唇弓曲线及唇红丰满度。必要时同期修复鼻畸形。结果采用个体化设计进行微小型唇裂整复术。可以保持1／3--2／3裂隙侧皮肤完整，恢复唇弓对称性、人中嵴形态及唇部丰满度。结论微小型唇裂整复术的个体化设计可以有效地恢复上唇的对称性及丰满度，减少手术瘢痕长度，修复后外观理想。     

双侧完全唇裂的个体化手术治疗

目的：探讨双侧唇裂修复术的个体化序列唇裂修复术式。方法：双侧完全唇裂患儿20例,均伴腭裂。患儿出生后10～40天内择期行双侧唇裂粘连术,6～10个月时行双侧唇裂整复术。唇裂整复术在前唇或侧唇附加小切口使双侧唇裂修复术后唇及唇弓形态对称,术中解剖口轮匝肌,复位后框式缝合;唇珠的形态由侧唇红唇肌肉瓣完成;红唇缘原有自然形态完整保存。结果：早期唇粘连术较好的抑制了前颌骨前突向前生长,也使前牙槽突裂隙减小,为后期的唇裂整复术创造了良好的条件。唇裂整复术后患儿创面均Ⅰ期愈合。鼻底宽度及丰满度均较满意,唇弓形态对称,无口哨畸形。随访10天～3个月,上唇静态及动态时外形均较好。结论：双侧完全唇裂整复时,采取序列治疗,对传统的原长整复方法进行改良优化,取长补短,另加一定的缝合技巧,可使术后上唇近期静态与动态均达到较满意的效果。     

A geometrically sound technique of vermilion repair in unilateral cleft lip.

In unilateral cleft lip, there is always a deficiency of vermilion on the medial side of the cleft, which can be augmented by techniques using excess vermilion from the lateral side of the cleft, like the use of a simple V-advancement flap. We developed a modification of Noordhoff's lateral vermilion flap that preserves the parallel relationship of the muco-vermilion line and the white roll but improves results in unilateral cleft lip patients. In a study of 30 patients undergoing surgical repair of complete unilateral cleft lip, we found that this method offers a superior alternative to the straight-line repair. This geometrically sound technique for vermilion reconstruction offers the cleft surgeon a simple and effective method for augmenting total lip height and creating a normal appearing Cupid's bow.     

Primary repair of unilateral cleft lip

The author's technique for the primary repair of unilateral cleft lip is described, including several improvements made over the last eight years. The technique aims at anatomical reconstruction of congenital anomalies of the orbicularis oris muscle as well as prevention of developmental disturbance and occurrence of deformity after surgical intervention. Cleft lip repair without muscle reconstruction may leave a concavity or a lump in the upper lip movement because of incomplete continuity of the orbicularis oris. No such result was found when muscle reconstruction was performed. In the primary repair of cleft lip, reconstruction of the orbicularis oris muscle is vital to preservation of good function and appearance of the lips.     

改良式Millard法修复单侧唇裂的临床应用

目的 探讨应用改良式Millard法修复单侧唇裂的效果.方法 对42例单侧唇裂患儿应用改良式Millard法,将健侧鼻小柱点移至患侧鼻小柱根部,充分分离错位的患侧口轮匝肌,将C瓣下的小肌束与患侧鼻束对合,部分重叠.结果 本组42例患儿,有3例因术后鼻腔分泌物多出现轻度感染,其余患儿均Ⅰ期愈合.术后随访1～36个月,平均6个月,效果满意.结论 改良的Millard法唇裂修补术可以恢复患儿患侧唇高、唇长,术后无肌隆起,效果满意.但Ⅰ期术后患儿的患侧外鼻形态须行Ⅱ期修复术才能获得满意效果.     

单侧唇裂继发畸形整复术的术式改良

目的 探讨改良术式修复单侧唇裂术后继发唇、鼻畸形的效果.方法 手术切几线与口鼻轮廓线相一致,片使鼻翼外侧脚整体旋转复位,重建鼻槛及鼻底,通过鼻腔的V-Y黏软骨瓣使鼻翼软骨上推,矫正鼻畸形.结果 自2000年以来,应用此方法对69例单侧唇裂继发唇、鼻畸形患者进行了修复,均取得较满意的效果,术后瘢痕线不明显.结论 轮廓线切口以及鼻翼软骨上推复位的方法符合唇、鼻的解剖特征,是一种较好的手术方法.     

单侧唇裂的人中窝修复

目的　重视人中窝不显和移位的修复，从而提高单侧唇裂的手术效果。方法　首先测量面部正中线和人中窝中线，然后参照健侧人中嵴，确定患侧人中嵴的位置及切口线，根据面部正中线与人中窝中线在人中窝顶部分开的距离，调整人中窝的位置。结果　８４例是在初次手术时进行人中窝修复，其形态自然，人中凹陷明显。４１例是在继发畸型手术时修复人中窝，其面积缩小、人中凹陷变浅。结论　人中窝在上唇形态中占重要地位，其修复在改善“唇裂面容”有重要意义。     

Muscle repair in unilateral cleft lip, based on findings on electrical stimulation.

The appearances, distribution, and direction of muscle in the unilateral cleft lip as indicated by electrical stimulation are described. The findings differ from those reported by Fara and associates in their dissections in that functionally the fibers do not appear to parallel the margin of the cleft. Based on these findings, a method of layer-by-layer, step-by-step closure of the unilateral cleft lip is described that attempts to split the orbicularis bulge and advance the lateral muscle into the philtrum to a position more nearly imitating the direction and extent of the muscle in a normal lip.     

Mohler''s法修复单侧唇裂的特点分析

目的：采用Mohler‘s手术方法修复单侧唇裂，分析与常规方法的不同设计，提出在手术过程中应该注意的问题方法：通过对随机选择Mohler‘s手术方法的患者的手术效果分析，提出Mohler‘s手术方法的特点，阐明手术设计的思路和操作中应该注意的问题。结果：63例患者手术全部成功，近期效果满意。4例患者合并有小皮瓣的坏死，但不影响伤口愈合。结论：Mohler‘s手术方法设计主要借用了鼻小柱下半部的皮肤组织，从而设计的A瓣边长比Millanl Ⅱ型设计的长。因而3点下降比较充分，手术近期效果好。但是鼻底封闭采用的切口多，建议改为传统的鼻底封闭方法。手术后的缝合线容易成为直线方式，若不有意错开，容易出现术后伤口明显挛缩的现象。     

改良Millard法修复先天性单侧唇裂

目的：介绍Millard单侧唇裂修复术的改良方法并观察手术效果。方法：对49例先天性单侧唇裂应用改良的Millard法修复：改良I式不在患侧鼻孔下方作切口，减少了瘢痕形成；利用患侧干燥红唇组织重建健侧唇弓部分的红唇欠缺；利用小瓣“L”、“M”连同唇颊黏膜瓣来参与闭合梨状缘附近的伤口促进愈合；松解患侧鼻翼外侧脚及鼻腔内作松弛切口重建前鼻孔；灵活掌握“5～x”的返切和“C”瓣的旋转推进方向来延长唇高。结果：所有病例出院时双侧唇高相等，唇弓形态自然，鼻孔外观良好，效果满意。结论：该改良技术弥补了传统的Millard法术后易发生唇高不足、干燥红唇与湿润红唇错位等缺点，提高了美容效果。     

单侧唇裂的个体化修复设计应用

目的：探讨单侧唇裂的临床分型,根据分型制定个体化修复术式,评价手术效果。方法：50例单侧上唇裂患者,平均年龄4.8个月,包括单侧完全性唇裂、单侧不完全性唇裂,根据唇高分为4型,分别对各型应用个体化设计手术方法、制定术后效果评定方法,观察术后近期效果。结果：所有患者手术后近期唇弓、唇红、唇珠恢复好,鼻畸形得到改善。结论：单侧唇裂修复根据临床分型应用个体化唇裂修复设计,手术疗效满意。     

新生儿先天性单侧唇裂修复术的临床研究

目的：探讨新生儿单侧唇裂修复的临床治疗效果。方法：选足月健康正常体重单侧唇裂患儿，在出生后48h内行唇裂修复术。对手术效果随访，并与婴幼儿期唇裂修复结果进行比较。结果：新生儿期修复单侧唇裂，效果理想，经3个月至4年随访．唇修复形态的优良率为92．8％，与婴幼儿组相比唇形态优良率无明显差别，但出血少，费用低，住院时间短，家长普遍满意。结论：对先天性单侧唇裂新生儿进行早期修复是安全的，且效果令人满意。