Three-dimensional analyses of nasolabial forms and upper lip surface symmetry after primary lip repair in patients with complete unilateral cleft lip and palate

Purpose

To analyze three-dimensional (3D) nasolabial forms and upper lip surface symmetry after primary lip repair in children with unilateral cleft lip and palate (UCLP).

唇缘红唇瓣在单侧唇裂红唇整复中的临床观察

目的:探求一种实用的修复单侧唇裂唇峰及唇珠的手术方法。方法:25例单侧唇裂患者应用旋转健侧唇缘红唇瓣重建唇峰唇珠。在术后第7天,由3名专科医师进行主观和客观评价。结果:所有患者健、患侧唇峰对称,唇红饱满,唇珠明显,干湿线(红线)恢复整齐。对称性的客观评价数值大多数在0.91～1.10之间,接近正常人群。结论:旋转健侧唇缘红唇瓣,能够较好地恢复单侧唇裂的红唇解剖结构。术式设计简单,定点明确具体,手术效果良好,是一种可靠实用的单侧唇裂红唇修复术式。     

The effect of a small triangular skin flap on vermillion height after cleft lip repair: a photogrammetry study

During primary cleft lip repair, a small triangular flap of about 2 mm is sometimes required to achieve better symmetry of Cupid’s bow. The aim of this study was to evaluate the symmetry of Cupid’s bow, with and without the use of a small triangular skin flap (STSF). Forty-five children who underwent the repair of unilateral cleft lip between January 1999 and December 2000 were recruited. Twenty children had a STSF included in the repair (STSF group) an d 25 children underwent the same repair without the STSF (NSTSF group). Vermillion height was measured on the cleft and non-cleft sides using reference points. The t-test was used to compare the vermillion height ratio between the two groups. The mean age at surgery was 4 ± 1.3 months in the STSF group and 4.3 ± 0.6 years in the NSTSF group. There was no significant difference in vermillion height ratio at 5 years of age between the patients in the two groups. Thus, there is no difference in vermillion height ratio with or without a STSF in cleft lip repair. The use of a small triangular skin flap needs to be assessed carefully, as it will create an unsightly scar over the philtrum area.     

单侧唇裂修复术中唇红三角瓣术前术后定量分析

目的:单侧唇裂红唇修复中唇红三角瓣的设计进行术前数据的定量分析,及通过术后数据的定量分析对术后效果进行评价。方法:青岛大学附属医院26例单侧唇裂患儿,手术前后进行健患侧各项数据的测量,术前数据包括健患侧唇长、干唇长、唇红三角瓣边长及底长;利用医学统计学方法得出术前数据的相关性并进行唇红三角瓣的设计,为单侧唇裂唇红修复时三角瓣的设计提供理论参考。术后测量数据包括健患侧唇长、干唇高度及唇高,运用医学统计学分析健患侧有无差异,从主观及客观两方面分析术后唇红部形态、对称性及患儿上唇唇红部形态等,综合评价手术中设计唇红三角瓣的效果。结果:唇裂裂隙程度与唇红三角瓣底长有明显的相关性,术前健侧与裂隙缘唇峰干唇的高度差和红唇三角瓣底长呈正相关(P＜0.05);26例唇红修复主观评价项平均得分均大于4分,客观评价术后健患侧干唇高度、唇高、唇长均无差异,整复效果令人满意。结论:依照本文设计唇红三角瓣的方法修复单侧唇裂可使上唇唇红获得良好形态效果。     

Kapetansky-Juri Technique to Correct the Whistlers Lip in the Multiple Operated Cleft Patient

Purpose

One of the common sequels of a cleft lip repair may be “whistling lip deformity” but other deformities are also seen particularly in failed or multiple resurgery cases. This retrospective study was carried out to evaluate the usefulness of “Kapetansky-Juri” advancement flap technique to correct such deformities.

Methods

Ten patients of bilateral cleft lip with history of minimum five failed cleft lip surgeries and having residual lip deformity were operated using “Kapetansky-Juri” advancement flap technique and were followed up to minimum 36 months.

Results

All patients showed good tissue fullness and complete correction of the deformity. There was no contracture of surrounding skin or vermilion during follow-up period. In eight patients minimal scar formation was seen while two showed midline scar formation.

Conclusion

No tissue loss due to vascular insufficiency was observed. The technique gives good tissue distribution and minimal surface scar formation.     

应用一侧颊肌粘膜瓣修复全下唇唇红缺损的初步报告

目的：介绍应用颊肌粘膜瓣修复全下唇唇红缺损的经验。方法：外伤和肿瘤切除后引起的4例全下唇唇红缺损行蒂在121角带血管蒂的颊肌粘膜瓣转移修复，术后观察红唇形态和功能的恢复情况。结果：全部颊肌粘膜瓣完全成活，无感染、血肿、导管或神经损伤及张121障碍。红唇的长度、高度、厚度及感觉都得到恢复。结论：蒂在121角的颊肌粘膜瓣能提供足够的组织修复全下唇唇红缺损，术后形态和功能恢复好，不需二期断蒂。     

Three-dimensional Analysis of Lip Changes in Response To Simulated Maxillary Incisor Advancement

ObjectiveTo assess the immediate response of lips in three dimensions (3D) resulting from simulated maxillary incisor advancement.Materials and MethodsIncremental maxillary incisor advancement was simulated by placing wax of increasing thickness (+2 mm, +4 mm, +6 mm) on the incisors of 20 participants, and the induced lip changes were recorded using 3D stereophotogrammetry. The induced displacement of lip landmarks was quantified using 3D image analysis software. Data were analyzed using a repeated-measures analysis of variance (ANOVA) after adjusting for age and sex of the study participants.ResultsA large interindividual variation in lip response to simulated incisor advancement was observed. A significant overall effect on 3D lip changes was found for increasing values of simulated incisor advancement (F = 13.2; P < .001) as well as significant differences between anatomical landmarks of the lip (F = 7.4; P < .01). Most points moved outward and anterosuperiorly, except the midpoint and corners of the lip. Greatest movement was observed in the sagittal plane, followed by the vertical and transverse planes.ConclusionsMaxillary incisor advancement significantly affects upper lip change in three planes of space: particularly the anteroposterior plane, in which the response to simulated advancement appears to be nonlinear.     

Dynamics of a smile in different age groups

Objective:To evaluate smile in different age groups and to detect gender differences in smile.Materials and Methods:Digital videographic records of 241 randomly selected subjects were obtained for smile analysis. The subjects were divided into four groups by age (15–20 years, 21–30 years, 31–40 years, and 41–50 years). Each group was further subdivided by gender. After 41 subjects were excluded, the smile dimensions of 200 subjects were analyzed by two-way multivariate analysis of variance (MANOVA) with Duncan''s multiple range post hoc test.Results:All dynamic measurements (change in upper lip length, upper lip thickness, commissure height, and intercommissural width from rest to smile) decreased with age in both males and females. Changes in upper lip length and commissure height on smiling were greater in males as compared with females of the same age groups. Changes in intercommissural width on smiling were greater in females as compared with males in all age groups.Conclusion:Smile changes with increase in age, and the changes differ between males and females. Females had a wider smile as compared with males of similar age groups.     

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background

The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero-premaxillary suture.

Material and Methods

4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla.

Results

The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars.

Conclusions

To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are required. Key words: Protruding premaxilla, bilateral cleft lip, vomerine ostectomy, one stage surgery, Millard II technique.     

唇裂整复术的现代概念

目的：结合单侧唇裂整复术的最新进展对唇裂修复更精细的成形技术进行探讨，提出唇裂整复术的现代概念。方法：现代唇裂修复术的概念主要对人中嵴的再造、鼻堤的成形和红唇的修复提出了更精细的要求，对旋转推进原则中Ｃ瓣的应用也有了新的认识。本文对82名单侧唇裂进行了临床应用，堤状隆起和星状结节的再造保证了鼻堤的恢复；通过内缝合技术恢复鼻唇沟及上唇的立体形态；白唇高度的恢复根据具体情况，C瓣应用三种方法的不同选择对畸形的矫正更为合理；人中嵴采用肌缘错位缝合进行再造；红唇的整复强调了干性红唇、湿性红唇及唇吻线的重要性。术后第3个月，以白唇高度、上唇形态、朱缘弓、红唇形态、鼻穹隆、鼻堤、唇部疤痕7个内容的20个项目对唇裂术后效果进行综合评估。结果：随访例数74例，随访率90．00％。58例整复效果理想，16例整复效果一般。在7个内容中，除鼻穹隆和鼻堤的整复整复效果相对欠佳外，其他内容均可以达到比较满意的效果。结论：唇裂修复术概念上的进步对保证唇裂的整复效果有着重要意义。     

Tumors of the labial mucosa: a retrospective study of 1045 biopsies

Background To investigate the relative frequency of localized mucosal swellings of the upper and lower labial mucosa, the clinical-pathological diagnosis agreement and whether patient’s age and gender and tumor’s site and size may raise the suspicion of neoplasm. Material and Methods Retrospective analysis was performed on upper or lower labial mucosal tumors, histopathologically diagnosed between 2009-2018. The diagnostic categories developmental/reactive tumors, benign and malignant neoplasms were associated with patient’s age and gender and tumor’s site and size; clinical-pathological diagnosis agreement was, also, evaluated. Results Overall, 1000 (95.7%) developmental/reactive tumors, 35 (3.3%) benign and 10 (1%) malignant neoplasms were found. Upper/lower lip tumor ratio was 0.14:1. The diagnostic category was significantly associated with age (p<0.0001), site (p<0.0001) and diameter (p<0.0001). Age ≥60 years, tumor’s location on the upper lip and diameter >1cm were independent predictors for neoplasms. Patients presenting 2 or 3 of these variables were 20.2 times (p < 0.0001) or 33.6 times (p <0.0001), respectively, more likely to have a neoplasm. Complete/partial agreement between clinical and pathological diagnosis was seen in 96.3% of the cases. Conclusions Most lip tumors involve the lower lip and are reactive, but upper lip tumors measuring >1cm in patients≥60 years have significantly higher probability to be neoplasms. Key words:Lip, tumor, neoplasm, carcinoma, cyst.     

Lip reconstruction: an anthropometric and functional analysis of surgical outcomes

Postoperative evaluation of results of reconstructive procedures of the lips mainly consists of describing the technique, complications and subjectively interpreted patient photographs. The authors present a photo-assisted pre- to postoperative evaluation of reconstructive procedures of the lips based on anthropometric measurements and functional outcome. Forty-eight patients underwent partial or full thickness excision of tumours of the lips and subsequent reconstruction. An analysis of standardized pre- and postoperative photographs included measurements of intercanthal width, mouth width, philtrum width, lateral upper lip height, upper and lower lip height, cutaneous upper and lower lip height, upper and lower vermilion arc and upper and lower vermilion height. Assessment of functional outcome consisted of the evaluation of oral competence, changes of oral opening and sensation. The effects on the described parameters were analysed, when partial or full thickness reconstruction had to be performed. Intercanthal mouth width index, vermilion arc index, vermilion and cutaneous total lower lip height index showed statistically significant effects postoperatively which indicates a postoperative tightened lower lip, when full-thickness excision was performed. In all patients the indices were proven reproducible and reliable. The standardized measurements described are accurate and objective for evaluating postoperative results.     

Short term results of philtrum reconstruction with an orbicularis oris muscle flap in cleft patients

PurposeIn the treatment of philtral ridge deficiency in cleft lip patients, optimal results are difficult to obtain due to visible scarring following surgery. The purpose of this article is to introduce a novel strategy for philtrum reconstruction along with an evaluation of postoperative outcomes of this technique.MethodAll patients with a deficiency of the philtrum underwent reconstruction of the philtral ridge and upper lip using an orbicularis oris muscle flap with a specific re-suturing technique in our study. The convexity of the philtral ridge was evaluated pre- and postoperatively at rest and while puckering using patient photography as well as three-dimensional simulation technology. Postoperative outcomes and complications were assessed during follow-up, including a patient satisfaction survey.ResultsThirty cleft lip patients underwent treatment in this study using a specific orbicularis oris muscle re-suturing technique. The average age of the 13 male and 17 female patients was 31.5 years. The follow-up period ranged from 6 months to 3.5 years with an average of 10.3 months. Postoperative results showed an aesthetic reconstructed philtral ridge with stable outcome. Complications included acute infection (1 case) and temporary stiffness of smile (3 cases). No systemic complications occurred. All patients were satisfied with their results, and none required further surgery.ConclusionWe propose a simple, effective, and reproducible technique involving an orbicularis oris muscle flap for the creation of the philtral column in secondary cleft lip deformity. Our approach allowed aesthetically pleasing and stable outcomes. Although the short-term results of the philtrum reconstruction seem to be adequate there is no information on the long-term situation, and therefore no general recommendation to adopt this method can be given.     

Three-dimensional virtual technology in reconstruction of mandibular defect including condyle using double-barrel vascularized fibula flap

ObjectiveThe aim of this study is to demonstrate the reconstruction of mandibular defects including the condyle using a double-barrel vascularized fibula flap aided by three-dimensional virtual technology.MethodsTen patients with the type H mandibular defects, who had undergone mandibular reconstruction using a double-barrel vascularized fibula flap, were reviewed for this study. Prior to the surgery, the patients CT scan data were analyzed virtually using SimPlant Pro? software (version 11.04). The simulation allowed construction of an individual mandibular model serving to guide the clinical operation.ResultsThe preoperative virtual surgery greatly benefitted the actual surgery. The vertical height of the neomandible and facial contour were precisely predicted. Some minor complications were encountered. Postoperative three-dimensional reconstruction revealed a close match with the simulated condyle.ConclusionA double-barrel vascularized fibula flap can provide sufficient bone, both in length and vertical height, for the reconstruction of a type H mandibular condylar defect. Combined virtual three-dimensional reconstruction and rapid prototyping can improve postoperative outcomes in mandibular reconstruction.     

单侧隐性唇裂整复方法的研究

目的：探讨单侧隐性唇裂的修复方法及疗效。方法：对25例单侧隐性唇裂患者采用改良唇裂修复术进行手术治疗,C瓣中的肌肉向外旋转与鼻翼基底的口轮匝肌缝合,为了恢复唇弓的对称性,患侧唇峰上方设计三角形皮瓣。结果：25例患者中,伤口均Ⅰ期愈合,术后唇弓和上唇的形态恢复良好,患侧人中嵴较明显,鼻畸形得到明显改善。结论：改良唇裂修复术治疗单侧隐性唇裂可以有效地恢复上唇的对称性和丰满度。     

�Ӽ�����Ӥ�������������ֵ�����о�

目的 探讨赣籍汉族婴儿唇鼻体表特征,为唇裂治疗及治疗后效果评估提供可参照的正常值范围。方法 采用人体测量学的面部基本测量指标及Farkas建立的系统化颌面部人体测量学直接测量法,随机抽取2012年6—8月在江西省儿童医院行健康体检的赣籍105名3 - 12月龄正常汉族婴儿,对其唇鼻体表进行测量,其中3 - 6月龄组49名（男29名,女20名）,7 - 12月龄组56名（男38名,女18名）,测量结果应用SPSS17.0软件包进行统计学分析。结果 获得赣籍3 - 6月龄及7 - 12月龄正常汉族男、女婴儿唇鼻体表形态的基本均值和标准差。3 - 6月龄组男婴鼻尖高度、唇弓内侧嵴、唇峰间距及鼻孔底宽均大于女婴（均P 〈 0.05）;7 - 12月龄组男婴上唇高、唇弓内侧嵴、唇峰间距、鼻孔底宽均大于女婴（均P 〈 0.05）。结论 赣籍汉族婴儿唇鼻部某些测量指标值存在性别差异,并随月龄和体重增长呈现有规律的变化,为婴幼儿唇裂合理的个体化治疗提供了可参照依据。     

单侧唇裂红唇微结构成形

目的：提出单侧唇裂红唇微结构成形的设计原则和整复方法。材料：18例单侧孵裂患儿,年龄3-6个月,其中单侧完命唇裂6例,单侧不全唇裂12例。方法：18例单侧唇裂患儿在唇裂一期整复术时均按照红唇微结构成形的设计原则同期整复红唇。分别于术后即刻、术后1个月及术后6个月进行随访评估。评估方法包括主观视觉效果和干性黏膜高度恢复率。结果：远期红唇主观视觉效果评估,88．9％的患者为好的结果;远期干性黏膜高度恢复率为99．6％。结论：红唇微结构成形不仅可再造唇弓嵴的连续性。而且可恢复于性黏膜正常的高度及唇吻线,最理想地整复红唇结构形态。     

Evaluation of nasal reconstruction procedures results

Before undergoing a reconstructive procedures of the nose most patients ask how they will look postoperatively. Anthropometric measurements of the nose described by Farkas represent standard values. A comparison of pre- and postoperative anthropometric measurements may help to double-check the correctness of intraoperative “eye-balling” measurements with regards to postoperative appearance.Sixty-three patients underwent reconstruction of nasal ala, tip or dorsum. An analysis of standardized pre- and postoperative photographs included measurements of nose width, nose height, nasal tip protrusion, columella width, ala length, intercanthal width, mouth width, philtrum width, upper lip height, lateral upper lip height, cutaneous upper lip height and upper face height. Preoperative measurements were compared to data given by Farkas in young adults. Postoperative changes were evaluated clearly distinguishing between reconstruction of nasal ala, tip and dorsum.All anthropometric indices showed significant differences compared to the Farkas population. There was no significant pre- to postoperative change in any reconstructed region observed, indicating adequate intraoperative measurements.The application of Farkas’ anthropometric measurements described in this study showed reliable and objective results and can help to double-check the previous intraoperative measurements. The correct application of these surgical techniques leads to a satisfying and near to normal postoperative look of the patient.     

Three-dimensional creation of the peak of Cupid’s bow by muscle tension line group reconstruction in secondary cleft lip repair

The peak of Cupid’s bow is a unique three-dimensional structure. Traditional reconstructive techniques focus only on the correction of vermillion border malalignment and the vertical discrepancy between Cupid’s bow peaks from a two-dimensional perspective. The aim of this study was to introduce a novel technique – the muscle tension line group reconstruction technique – to recreate the Cupid’s bow peak three-dimensionally in secondary cleft lip repair. With this technique the orbicularis oris muscle is divided into two flaps: a lateral one composed of pars marginalis and a medial one composed of pars peripheralis. The full thickness of the medial flap is sutured to the deep layer of the lateral flap, and the end of the lateral flap is then sutured to the dermis lateral to the philtral dimple to accentuate a depression. In this way, the two muscle flaps exert opposing skin traction on each side of the peak, which improves the vertical height as well as the lateral projection of the Cupid’s bow peak. The postoperative outcomes indicate that this is a reliable technique for three-dimensional restoration of the Cupid’s bow peak, with a stable and natural reconstructive appearance.     

Free thoracodorsal,perforator-scapular flap based on the angular artery (TDAP-Scap-aa): Clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects

PurposeThe reconstruction of oromandibular defects can be challenging, particularly when considerable amounts of bone and soft tissues are lost. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Here we present a chimeric, thoracodorsal perforator-scapular free flap based on the angular artery of the subscapular system (TDAP-Scap-aa) as an alternative technique for single flap reconstruction of extensive oromandibular defects.Materials and methodsThe authors studied patients who underwent reconstructions of extensive oromandibular defects with a TDAP-Scap-aa free flap. The operative technique and the clinical experiences are described. Postoperatively, surgical complications were classified with the Clavien-Dindo Classification.ResultsFive male patients (59.4 ± 8.8 years) were treated with the TDAP-Scap-aa. Average sizes for harvested hard and soft tissue components, which are both included in the flap and completely independently from each other, were 10.4 ± 1.5 cm of bone length, 2.6 ± 0.3 cm of bone height, 11.6 ± 4.8 cm of skin paddle length and 8.4 ± 1.7 cm of skin paddle width. The overall mean operation time (cut-suture) was 14.6 ± 0.9 h. The postoperative follow-up was 6 months. No complications requiring surgical treatment as well as donor site nerve damages were observed.ConclusionsIn comparison to other double free flaps, the TDAP-Scap-aa offers several advantages such as higher amounts of hard and soft tissues without prolonged operation times, and provides satisfying aesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve structures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction.