Abbe瓣联合开放路径鼻整形法矫正双侧唇裂术后继发畸形的临床应用

目的探讨Abbe瓣转移联合开放路径鼻整形术矫正双侧唇裂术后继发唇、鼻畸形的手术方式。方法应用Abbe瓣联合开放路径鼻整形术矫正双侧唇裂术后继发畸形5例。手术分两期施行,Ⅰ期行鼻整形及Abbe瓣转移术,Ⅱ期行Abbe瓣断蒂术。结果所有患者随访8～12月,仅1例红唇缘不齐需再次手术修整,其余唇、鼻畸形均明显改善。结论对于严重的双侧唇裂术后继发唇、鼻畸形的患者,应用Abbe瓣转移矫正上唇畸形及开放路径鼻整形术矫正鼻畸形,是一种可行、有效的术式。     

应用鼻腔前庭皮肤成形术矫正唇裂继发鼻畸形

目的探讨鼻腔前庭皮肤成形术在唇裂术后继发鼻畸形矫正术中的作用。方法1999年1月～2004年3月收治的94例患者,在错位组织充分松解后,利用鼻腔前庭皮肤的旋转、推进、折叠、Z字改形,达到组织的复位塑形。术后用鼻模固定塑形3～4个月,防止术后瘢痕挛缩变形。结果患者鼻唇外形获得显著的改善,随访3～24个月,效果良好。结论鼻腔前庭皮肤成形术对唇裂术后继发鼻畸形矫正术中的鼻软骨复位,SILL抬高,鼻翼塌陷矫正,鼻翼外脚复位,均有重要作用,同时也能避免鼻外及鼻面沟处的辅助切口。     

鼻翼软骨肌肉环的修复在唇裂鼻畸形中的作用

目的分析唇裂鼻畸形发生的病理解剖学基础,探索更加符合解剖特点的唇裂鼻畸形矫正方法。方法对30具成人尸体、1具单侧唇裂胎儿标本行大体解剖,并结合临床102例唇裂鼻畸形患者的术中所见,进行比较解剖研究。结果正常人外鼻下端存在由鼻肌翼部、鼻肌中隔部与鼻翼软骨形成的环状结构,而唇裂患者的这个环状结构发育不良。据此设计了旨在修复鼻翼软骨环的手术方法,临床应用102例,效果良好。结论鼻翼软骨肌肉环是外鼻下端重要的解剖结构。唇裂患者因鼻翼软骨肌肉环发育不良,进而导致了鼻部肌力的失衡。因此,唇裂鼻畸形矫正中修复鼻翼软骨环状结构具有重要意义。     

单侧唇裂继发鼻畸形矫正技术的研究

目的探索单侧唇裂继发鼻畸形的矫正技术。方法将扁大的裂侧鼻翼较健侧“多余”的部分组织形成鼻翼瓣,用于重建鼻孔基底部鼻槛、抬高鼻翼外侧脚。充分游离裂侧鼻翼软骨的内侧脚上部、穹隆部及外侧脚,调整鼻孔大小及形状,使双侧对称后,在适当位置予以固定。再用自体肋软骨按所需形态雕刻后,分别植入鼻背、裂侧鼻翼脚及鼻孔底部以抬高鼻梁、裂侧鼻翼外侧脚及鼻孔基底。结果矫治18例,术后两侧鼻翼、鼻孔、鼻孔基底、鼻翼外侧脚、鼻小柱基本对称,效果满意。结论改进的裂侧鼻翼瓣加鼻翼软骨悬吊法是矫正唇裂鼻畸形的一种有效方法。     

“改良Barsky”法在唇裂二期上唇畸形修复中的应用

目的总结应用改良Barsky法修复单侧或双侧唇裂二期畸形的经验。方法依照Barsky法根据Barsky法的基本原则设计固定方向的切口及瘢痕切除范围,所有切口均矫正为直线,切开后形成类似"Z皮瓣"的切口,美容缝合。结果应用本方法修复后的25例患者愈合良好,双侧唇峰和唇珠外观接近正常,上唇对称度增加。结论应用改良Barsky法修复唇裂修复后期上唇畸形,可以较好的延长上唇白唇长度,改善唇弓形态。由于该方法具有对称性,可以同时应用于单侧或双侧唇裂后期修复。     

Abbe皮瓣修复上唇鳞状细胞癌术后缺损的效果分析

目的探讨皮瓣修复上唇鳞状细胞癌术后缺损的临床疗效。方法对11例上唇鳞状细胞癌患者行根治术,术后缺损采用abbe皮瓣分两期进行手术修复,并对修复效果进行观察。结果仅1例患者出现Ⅱ°小口畸形,经再次予小口畸形矫正术后,外形恢复好。其余患者均临床治愈,术后皮瓣成活,口唇外形良好,进食、言语功能不受限,患者满意。结论 Aboe皮瓣修复上唇鳞状细胞癌术后缺损的效果好,唇功能不受限,患者满意度高,可作为上唇鳞癌术后缺损修复的常规术式。     

先天性双侧唇裂术后继发唇珠缺损的再造修复

目的纠正先天性双侧唇裂术后遗留的唇珠缺损或唇珠不显畸形。方法采用唇珠区局部组织填充或组织瓣转移方法矫正此类畸形。结果自2000年始临床再造唇珠43例外形丰满。结论双侧唇裂术后唇珠缺损或唇珠不显的矫正需针对具体特点,采用不同的方法,才能取得良好的手术效果。     

一种新的隆鼻术——软骨丁

软骨丁技术已经应用于鼻部整形。方法是将软骨切碎后以筋膜或生物材料包裹再植入体内,优点是可防止软骨植入体在肿胀消退后表面不平整的发生。用于唇裂鼻畸形患者或假体置入隆鼻失败修复病例,已取得满意疗效。手术要点:取第8肋软骨,雕刻中隔柱状移植体和鼻背移植体。剩余软骨切成1mm左右     

应用去上皮的瘢痕组织瓣矫正面部畸形

目的探索应用瘢痕组织瓣矫正面部各种畸形的手术方法。方法瘢痕组织去上皮后,根据需要设计瘢痕瓣蒂的位置和瓣的体积,形成合适的瘢痕瓣,并将其转移到受区作为充填、支持材料,矫正唇裂二期需整复的鼻底缺损、唇珠和鼻尖凹陷、口鼻瘘和面颊部瘢痕伴瘢痕下组织缺损凹陷等畸形,共14例。结果14例均获满意效果。结论在面部,某些原已存在的瘢痕,可以形成去上皮后的瘢痕瓣,用作充填或支持材料,矫正畸形。     

改良双叶皮瓣修复鼻前庭基底细胞癌术后创面一例

目的探讨改良双叶皮瓣修复鼻前庭基底细胞癌术后创面缺损的方法和疗效。方法设计由局部菱形皮瓣和鼻唇沟皮瓣组成改良双叶皮瓣,修复1例鼻前庭基底细胞癌患者术后创面缺损。结果术中缝合切口无明显张力,鼻外形无明显变化。术后皮瓣成活良好,随访1个月术区无畸形,上唇、鼻孔外形均正常。结论改良双叶皮瓣修复鼻前庭基底细胞癌术后皮肤缺损,效果良好。     

Treatment of developmental defect of upper lip with carbon dioxide laser radiation (CO2): first surgical time.

With the exception of the cleft lip, developmental defects (DD) of the lip are rare. The upper lip originates from the ectomesenchyme and is formed by the merging of the nasal medial and lateral processes with the maxillary process. Disturbances during this formation period can cause DD with functional and/or esthetic repercussions. We present a case of DD of the upper lip in a patient with a history of progressive growth of the left lateral portion of the upper lip that occurred from the time of birth until the age of 22 years. Clinical examination revealed hypertrophy of the area from the left philtral columns to the left commissure of the lip, extending the portion of the surface mucosa creating a flaccid and asymptomatic tissue mass. All other buccal structures appeared to be within normal limits and without any evidence of defects or deformities. In the surgical planning we decided to carry out corrective surgery in two phases. The first phase accomplished a conservative excision of the total abnormal labial tissue mass with a CO2 laser radiation (5 W in continuous mode, bunch diameter Phi = 0.6 mm with a power density of 768 W/cm2 and fluency of 0.231 J/cm2) being careful to preserve the vermilion portion of the lip. Postsurgical clinical evaluations were done every three days until the skin sutures were removed and then every seven days until two months post surgery. While the entire mass of excessive tissue could not be completely removed, the removal of the excessive mucosal tissue produced a very good outcome relative to lip function, with a good esthetic result without scarring, and good tissue mobility. The results showed that the CO2 laser is an extremely useful instrument that can provide excellent control of the surgical field and allow for healing that produces excellent functional and esthetic results.     

Repair of nasal tip and alar defects using cheek-based 2-stage flaps: an alternative to the median forehead flap

OBJECTIVE: To describe our use of cheek-based 2-stage transposition flaps for repairing Mohs surgery defects of the lower third of the nose. DESIGN: Retrospective case series. SETTING: Private dermatologic day surgery facility.Patients Twenty-eight patients with defects of the lower third of the nose after Mohs surgery.Intervention Ten alar and 18 nasal tip defects repaired using cheek-based 2-stage transposition flaps. MAIN OUTCOME MEASURES: Acceptability of procedure to patient, complications, and appearance from photographic records. RESULTS: The procedures were well tolerated and achieved good cosmetic results without major complications. CONCLUSIONS: These flaps allow repair of extensive defects of the nasal tip and ala with the patient under local anesthesia. This approach provides an alternative to the median forehead flap for nasal tip repairs.     

Double Cross Lip Flaps for Reconstruction of the Lower Lip

Squamous cell carcinoma of the lower lip is a common tumor. Of the many methods available for reconstructing lower lip defects after radical excision, we found double cross lip flaps from each lateral side of the upper lip philtrum rotated into the defect of the lower lip to be an effective method, not only functionally but also cosmetically. The main reason why satisfactory results were obtained by this procedure is that the anatomical structure (skin-orbicularis oris muscle-mucosa, vermilion) of the upper lip is very similar to that of the lower lip. Our experience is with double cross lip operations in the management of lower lip cancers are described.     

Van der Woude Syndrome. A Case Report

Abstract: We describe several members of a family with Van der Woude syndrome, a genetic and congenital malformation syndrome with autosomal dominant inheritance and 70% to 80% penetrance with variable expressivity. It is characterized by clinical signs localized to the face, such as bilateral or unilateral pits on conical elevations in babies or extensive depressions in adults, both in the vermilion border of the lower lip, with cleft lip, with or without cleft palate and uvula. Small accessory or heterotopic salivary glands empty into sinuses or fistulas in the lips. This eight member family had various clinical signs of the condition. All had cleft lip and palate. We studied the major characteristics of the eight patients and describe histopathologic and immunohistochemical features.