唇裂的鼻小柱侧面皮瓣修复法

目的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个重要美容结构的塑造中的缺欠,使修复后的上唇丰满、松动。方法在鼻小柱裂侧面形成一个矩形瓣,将其与人中一起垂直下降,补充裂侧唇人中的长度不足和保持朱缘弓在下降的正常位。结果 3年来,共用新法修复单侧唇裂23例,双侧唇裂9例,继发唇裂畸形14例。都没有常用方法的缺点。结论唇裂的鼻小柱侧面皮瓣修复法是较常用手术更符合整形外科从隐蔽处采取组织来修复组织缺损的原则的新方法,可以取得更好的形态效果。     

唇裂的鼻小柱侧面皮瓣修复法

目的　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个重要美容结构的塑造中的缺欠，使修复后的上唇丰满、松动。方法　在鼻小柱裂侧面形成一个矩形瓣，将其与人中一起垂直下降，补充裂侧唇人中的长度不足和保持朱缘弓在下降的正常位。结果　３ 年来，共用新法修复单侧唇裂２３ 例，双侧唇裂９ 例，继发唇裂畸形１４ 例。都没有常用方法的缺点。结论　唇裂的鼻小柱侧面皮瓣修复法是较常用手术更符合整形外科从隐蔽处采取组织来修复组织缺损的原则的新方法，可以取得更好的形态效果。     

前颌过分前突的双侧唇裂修复术

我们仿宋儒耀［１］直线法修复前颌过分前突的双侧唇裂５２例,收到较好效果。１　临床资料　　本组５２例,年龄６个月～１岁３１例,１～３岁１４例,３～６岁７例。４０例为双侧完全裂,１２例为混合裂,全部病例都合并有双侧完全或不完全腭裂及牙槽裂。２　手术方法沿用宋儒耀直线法［１］,定点画线及手术步骤略有改动（图１,其中前唇直线为直线法,点线为改进法）。将前唇略展平定点,ｂ点较直线法略向中移,以设计出近似正常的人中形态（幼儿人中宽度在４～６ｍｍ）,而不是以前唇原有形态作为人中,这样形成的唇高ａ—ｂ线较直线法…     

无锡地区青年人人中角与唇峰角的测量研究

目的:测量无锡地区正常青年人人中角与唇峰角,评价两者之间相互关系,及对人中美学形态的贡献。方法:2014年6月-2015年6月对无锡地区100名20~25岁正常青年进行全面部照相并裁剪人中,对人中进行美学等级评分,并测量人中角与唇峰角,计算平均数及标准差,同组左右间采用配对t检验、不同性别组间独立样本t检验,P0.05差异有统计学意义。结果:人中角较双侧唇峰角略大,三者呈双侧对称"M"形。男性32号、女性8号人中评分最高。测得人中各角度数如下:人中角,男(141.9±8.6)°,女(142.2±6.4)°;右侧唇峰角,男(134.8±6.9)°,女(135.1±6.8)°;左侧唇峰角,男(134.8±6.6)°,女(135.0±7.0)°。正常人左右唇峰角间无差异(P0.05)。正常男女间测量参数均无差异(P0.05)。结论:人中整形需同时考虑人中角与唇峰角的相互关系,并参照测得的平均数值以及评分最高的照片为妥。     

口内入路功能性唇裂及鼻畸形修复术

目的：探讨应用口内入路进行功能性唇裂及鼻畸形修复术的手术方法,并分析其适应证。方法：白、红唇交界区域设计三角形皮瓣,结合口腔内粘膜切口入路,在恢复患侧唇峰、唇珠结构的同时,一次性完成口轮匝肌功能性重建、人中嵴的成形和鼻翼畸形的纠正。结果：本组30例患者伤口均为I期愈合,鼻底丰满度良好,鼻孔横置现象得到明显改善,人中窝及人中嵴形态良好。所有患者对轻微的白唇瘢痕能够接受,表示对治疗效果满意。结论：应用口内入路功能性唇裂及鼻畸形修复术具有手术后瘢痕轻微,减少术后瘢痕挛缩畸形的优点,结合口内切口入路可同期完成传统入路的各项操作要求,是治疗I度裂或隐裂较为理想的方法。     

口内入路法功能性修复唇隐裂

目的:探讨口内入路法修复唇隐裂的可行性。方法:白、红唇交界区域设计皮瓣,采用口内切口入路,完成口轮匝肌功能性重建、人中嵴的成形和鼻翼畸形的纠正。结果:本组12例患者伤口均I期愈合,并于术后3个月、6个月、1年随访,鼻底丰满度良好,鼻孔横置现象改善明显,人中嵴形态良好。所有患者家长对治疗效果满意。结论:采用口内入路法修复唇隐裂,在重建口轮匝肌环、改善鼻畸形、获得自然人中嵴的基础上避免了瘢痕,获得了美学、功能上的满意效果,是治疗隐裂一种理想的方法。     

鼻前庭矩形瓣法单侧唇裂修复术

目的：探讨鼻前庭矩形瓣法修复单侧唇裂的临床可行性，评价该方法的优越性。方法：应用遵循整形外科原则的鼻前庭矩形瓣法对80例单侧唇裂患者行立体三维修复。术后对外观及功能进行评价。结果：所有病例均Ⅰ期愈合。随访6个月～3年，除3例患儿红唇唇珠欠丰满，2例患侧鼻翼扁塌，2例切口有轻微瘢痕增长外，其余病例静态、动态效果良好。所有病例患侧唇峰均下降充分，两侧唇峰对称，人中形态好，人中嵴的形态接近正常。修复后的上唇更为丰满、松动，红唇丰满，唇珠明显。结论：应用鼻前庭矩形瓣法进行单侧唇裂的立体三维修复，符合整形外科原则，且不牺牲人中部位的组织及破坏了人中嵴、人中窝等重要美容结构。手术效果良好，值得推广应用。     

单侧唇裂三叶瓣修复术

目的 设计一种新的唇裂修复的手术方法,旨在减少术中组织损失,有效下降患侧唇峰,并使手术瘢痕更加符合人中嵴形态,且更有利于鼻尖的上抬和鼻底的成形.方法 唇裂修复分鼻尖、鼻底和唇部三个区域分别完成.健侧白唇区域设计三叶形皮瓣.上方二皮瓣梯次向鼻小柱外侧和鼻底旋转,分别用于修复鼻尖上抬后鼻小柱旁的组织缺损,并重建鼻底区鼻堤结构,剩余的下方皮瓣向患侧不加旋转而直接推进,与患侧皮瓣直接缝合,在下降唇峰并恢复患侧人中嵴形态的同时,使手术的切口瘢痕与健侧人中平行,形态更接近自然.结果 本组48例患者伤口均一期愈合,未发生任何血运障碍.唇峰下降满意,鼻底丰满度良好,鼻堤结构成形满意,同时鼻尖形态恢复较好,鼻孔横置现象得到明显改善,人中嵴形态良好.结论 应用三叶瓣术式可避免以往唇裂修复术唇峰下降不足或白唇附加切口的缺陷,无需三角瓣的补充.术中同时恢复鼻尖高度并得到足够的鼻底组织量和良好鼻堤形态,术后切口瘢痕与对侧人中嵴对称.     

朱唇:爱神之弓

口唇是一个多功能的混合性器官,还是构成人的容貌美的重要部位之一,娇艳柔美的朱唇是女性风采的突出特征,在达芬奇的著名肖像画《永恒的微笑》中,美就美在口唇上。口唇分为上唇和下唇,两唇之间的裂隙称为口裂(俗称口)。口裂的两端称口角。上下唇均由皮肤、口轮匝肌、疏松结缔组织及粘膜组成。唇的外形,由皮肤部、红唇部和粘膜部组成。由于红唇部极薄,没有角质层和色素,所以能透出血管中的血液颜色,而显得格外红润,极富魅力。此处也是女性涂抹口红的地方,在唇化妆中占有特别重要的地位。在上唇的中部有一个凹沟,名为人中,这是人类特有的结构,也是构成口     

正常儿童唇鼻部形态平面测量研究

对117名正常学龄前儿童唇鼻部形态结构进行平面数学测量,以期为儿童唇鼻部整形手术提供参考。研究结果显示:正常儿童唇鼻部形态除双侧唇高相对对称外,在侧唇高,唇红长度,鼻孔底宽度,唇峰口角距,唇缘长及人中切迹低点唇峰间距等方面存在数学上的不对称,其形态特征随性别不同而略有差异,且存在双侧结构趋于对称的相关关系。     

Unilateral complete cleft lip repair: orthotopic positioning of skin flaps.

The ideally repaired cleft lip should provide a symmetrical Cupid's bow, philtrum, and minimal scar. In the appearance of the upper lip, the philtrum plays a key role. The most popular method for unilateral cleft lip repair is the rotation-advancement technique introduced by Millard. This technique requires the rotation of the noncleft side flap in unilateral cleft lip. As the vertical discrepancy between the peaks of Cupid's bow is increased, the scarring becomes more evident. Also, where it crosses the philtral column in the oblique extension of the upper lip, it becomes apparent for the eye to notice. Thus, many surgeons have tried to modify this technique to improve the symmetry of the philtral columns. The philtral dimple is composed of centrally located thin dense subcutaneous tissue bordered by thick loose subcutaneous tissue producing the philtral columns laterally. The aim of this surgical modification is to form a more natural looking philtrum using its original anatomical structure. The tissue defect after rotation of the noncleft side flap is filled with the C flap, not the advancement skin flap from the cleft side. The C flap helps to form the upper philtral column into a more straight appearance. The skin flaps of the cleft side and noncleft side are placed either side of the philtral column, and the skin flap from the columella is not used for the repair of the philtrum. Twenty-five patients with unilateral complete cleft lip were repaired using this technique from 1996 to 1999. Adequate alignment of the Cupid's bow and symmetric philtral appearance were obtainable.     

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.     

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.     

双侧唇裂继发鼻唇畸形的综合整复治疗

目的　评价和探讨双侧唇裂术后继发鼻唇畸形的综合整复矫治方法。方法　 2 0 0 0年1月～ 2 0 0 3年 6月我们为 4 0例双侧唇裂术后继发鼻唇畸形患者进行了综合治疗。其中术前施行牙槽突裂髂骨松质骨植骨修复 2 8例 ,牙正畸治疗 2 2例 ;前牙义齿修复 2 0例 ,正颌外科手术或上颌骨牵引成骨手术 2 0例。完成上述治疗程序后行鼻唇二期整复手术。手术方法采用自上唇中央唇红、瘢痕缘、鼻小柱旁至双侧鼻孔内侧缘连续切口 双侧鼻翼沟及鼻孔底切口入路 ,行鼻小柱延长、鼻翼鼻孔轮廓成形、人中嵴、人中凹及唇峰唇珠重建术。结果　患者鼻唇外形均获得较前明显的改善 ,随访 3个月～ 3.5年 ,满意率达 95 %。结论　对双侧唇裂术后鼻唇继发畸形采用综合序列治疗 ,强调二期手术前牙 -颌基础框架的搭建 ,再采用本手术方法矫治鼻唇软组织畸形 ,效果自然稳定。     

Millard法修复单侧唇裂的分析和研究

目的：分析阐明Millard法在修复单侧唇裂中的优点和缺陷。方法：对30例单侧唇裂的患儿，应用Millard I或Ⅱ型法修复，同时在唇红缘裂隙处作一交叉三角辨的改良，并一期复位鼻翼软骨。结果：经6个月－1年的随访，解剖复位效果满意，瘢痕隐蔽，人中完整，唇红丰满，鼻翼软骨复位良好，鼻小柱得以延长。结论：Millard法是修复单侧唇裂较为理想的方法，应用交叉三角瓣修复唇红缘，弥补了Millard法唇红缘修复方面的不足。一期鼻翼软骨钝性解剖复位效果良好，符合东方人种的特点。     

榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形

目的探讨榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形的疗效。方法 2009年1月-2011年8月,收治43例单侧唇裂修复术后继发人中嵴畸形患者。男23例,女20例;年龄18～31岁,平均23.6岁。左侧26例,右侧17例。唇裂采用MillardⅠ式修复15例,MillardⅡ式修复28例。唇裂修复术至此次手术时间为15～30年,平均21.7年。术中切取双侧口轮匝肌肌瓣,水平分成上、下两层;双侧下层肌瓣相互重叠缝合,上层肌瓣形成榫卯型结构,缝合于皮下。结果术后患者切口均Ⅰ期愈合。40例患者获随访,随访时间6～34个月,平均13.4个月。双侧人中嵴隆起、对称,人中凹形态接近正常,上唇动态效果满意。术后6个月38例明显改善,2例改善不明显。结论榫卯型口轮匝肌肌瓣手术操作简便,修复单侧唇裂术后继发人中嵴畸形能较好恢复解剖结构,术后获得良好上唇外形和功能。     

Straight line repair of unilateral cleft lip: new operative method based on 25 years experience.

The resultant scar in the primary repair of unilateral cleft lip should ideally be straight and the mirror image of the philtrum on the non-cleft side. In 1993, we reported a new operative technique for unilateral cleft lip, in which we designed a straight line for the incision on the white lip. In order to produce the nostril floor, we used the white lip tissue in the area between the alar base and alveolus at the cleft side as a flap. We also used a small triangular flap above the white skin roll to prevent Cupid's peak from being drawn up. Unlike the rotation-advancement method, our technique does not leave a transverse scar at the alar base. Instead, it leaves a scar only along the line coincident with the natural philtral ridge. However, during observations of our patients, we noticed that the small triangular flap designed to be 1.5mm tended to become a conspicuous angular scar as the patients grew older. In addition, drooping of Cupid's peak on the cleft side was often observed with this small triangular flap. To make it less conspicuous, we made some modifications to the small flap above the white skin roll. With this new technique, we designed a semi-circular flap (1.5 x 3mm) above the white skin roll, instead of the small triangular flap. The suture line of our refined procedure draws a gentle curve, which looks almost straight because of skin elasticity. Moreover, the semi-circular flap causes less drooping of the upper lip than the triangular flap. We believe that revising the shape of the small flap on the white skin roll greatly improves patients' appearance. In this report, we present our refined techniques of primary repair of unilateral cleft lip.     

侧唇唇缘红唇肌瓣再造双侧唇裂患者唇珠及唇缘

目的:利用侧唇重要的解剖学指标,再造双侧唇裂人中部唇缘及唇珠,探求一种有效的功能性修复双侧唇裂唇缘及唇珠的方法。方法:2000年～2005年本院收治的唇裂患者中,双侧唇裂患者76例,男性54例,女性22例。年龄最大19岁,最小4/12岁。通过设计侧唇唇缘红唇肌瓣,旋转于前唇下方重建唇弓缘,该瓣末端红唇粘膜肌瓣再造唇珠的方法修复。结果:术后患者无1例裂开,无明显的口哨畸形,口轮匝肌连续完整,唇弓缘连续,唇弓自然生动,形态好。红唇丰满,红线连续,唇珠突翘明显。结论:唇缘红唇肌瓣可以较好地修复双侧唇裂下部重要解剖结构,唇缘红唇肌瓣的设计切取是手术成功的关键。     

Aesthetic considerations of the cleft lip operation

The results of a cleft lip operation are checked from the anterior, the profile, and the caudal views and even if the deformities are minimal, for aesthetic reasons they should be repaired. Philtrum length, philtrum shape, philtrum depth, nasolabial triangular area, vermilion thickness, Cupid's bow peak, horizontal upper lip groove, vermilion border, alar size, depth of alar groove, nasal deviation, nostril shape, nasal tip, columella height, sill shape, columella width, and facial balance of the anterior, profile, and caudal views are used as aesthetic checkpoints for the results of a cleft lip operation. If deformities are found, the aesthetic plastic surgeon should repair them to achieve a more satisfactory result. In addition, augmentation rhinoplasty, augmentation mentoplasty, or other craniofacial surgery may be performed.