双侧唇裂术后唇鼻畸形的美容整形术

目的 :探讨双侧唇裂继发畸形美容整形术的技术改进。方法 :采用两侧红唇上缘的小三角瓣插入到原人中的下方来延长上唇 ,及利用 2种方案修复鼻畸形。结果 :双侧唇裂术后唇鼻畸形Ⅱ期美容整形术12例均取得了比较明显的手术效果。结论 :此方法在唇峰重建、唇珠再造、人中凹形成及唇鼻畸形的矫正方面有比较独特的效果     

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。     

Comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using conchal composite grafts.

INTRODUCTION: Anatomical abnormalities and heterogeneous tissue deficiencies of the bilateral cleft lip nasal deformity challenges the cranio-maxillofacial plastic surgeon to create a functional, yet aesthetically pleasing nose. The authors propose a comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using composite conchal grafts. PATIENTS: Five children with bilateral cleft lip nasal deformities had nasal reconstruction using conchal composite grafts, averaging 5 years in age at time of surgery. Patient follow-up averaged 21 months. METHODS: An open tip rhinoplasty was performed using a 'V' shaped columellar incision. The conchal composite graft was obtained from the lateral aspect of the ear and was used to reconstruct the lateral alar mucosal defects. Conchal cartilage was used as a columellar strut. The columellar skin was closed in a 'V-Y' fashion, giving greater columellar length. RESULTS: Visual inspection confirmed that the cleft lip nasal deformity was improved in all patients. There were no postoperative complications. All patients had complete composite graft take with minimal donor site morbidity and deformity. CONCLUSIONS: This comprehensive rhinoplasty technique improves the abnormalities found in bilateral cleft lip nasal deformity by using the successful aspects of other methods and introducing the composite conchal graft.     

Secondary correction of bilateral cleft lip nose deformity

For correction of the bilateral cleft lip nasal deformity, a modified bilateral reverse U incision is used in combination with a short, forked flap; by using this combination, satisfactory lengthening of the columella, preserving the natural pout of the lip, can be obtained. We have applied this method to 12 cases undergoing secondary repair of bilateral cleft lip in the past 3 years, and the results of this treatment, along with representative photographs of some of our patients, are presented herein.     

The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.     

Dynamic presurgical nasal remodeling in patients with unilateral and bilateral cleft lip and palate: modification to the original technique.

OBJECTIVE: To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair. METHOD: The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force generated during suction and swallowing. A conventional intraoral plate is built with a nasal extension added to the labial vestibular flange. The nasal extension was modified and consists of three components. The palatal plate is left loose in the mouth to generate a discontinuous but controlled impact directed to the affected nasal structures during suction and swallowing. The principle aim of the DPNR technique in unilateral cases is to improve the deformation of nasal structures by straightening the columella, elevating the nasal tip, and remodeling the depressed cleft side alar cartilages. In bilateral cases, the aims are to elongate the columella and to obtain nasal tip projection. CONCLUSIONS: The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate.     

A new modified forked flap with subcutaneous pedicles for adult cases of bilateral cleft lip nasal deformity: from normalization to aesthetic improvement

In adult cases of bilateral cleft lip nasal deformity, an esthetically satisfying result can not be obtained only by manipulation inside the nose with the nasal tip pointing upward. The nasal tip should be made in a more anterior direction for nasal esthetic improvement. Additional tissue beyond the nose is needed, and the forked flap is a useful method in such cases. However, the blood circulation of long and narrow flaps containing the scar, especially after open rhinoplasty, is unstable. We have developed a new long and narrow forked flap that has a more stable blood circulation. The forked flap was made using two subcutaneous pedicles attached to the periphery of the each flap. We applied this flap to five adult cases of bilateral cleft lip nasal deformity. Four of the cases had the scar associated with the flying bird incision, and one case required no treatment after the primary repair. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the profile was esthetically improved. In the final stage of correction for adult cases of bilateral cleft lip nasal deformity, this method, making maximum use of the tissue containing the scar in not only the white lip but also the vermilion, is very effective. It is very important to obtain nasal esthetic improvement for the adult patient with bilateral cleft lip nasal deformity.     

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。     

应用鼻翼基部内侧组织瓣修复单侧完全性唇裂

目的 探讨利用鼻翼基部内侧组织瓣修复单侧完全性宽唇裂的方法。方法 选择单侧完全性唇裂78例,手术时确保健患侧唇边长相等,利用患侧鼻翼基部内侧组织瓣增加患侧唇高,使健患侧的唇高对称。其余操作同“Millard”术式。结果 66例术后健、患侧上唇对称,唇高及唇边长两侧相等,瘢痕不明显。唇珠形态好。术后1．5年复诊,84．6％效果比较理想;10例术后效果一般;2例需Ⅱ期修复。结论 对于较宽的单侧完全性唇裂,利用翼基部内侧组织瓣代偿组织缺损。是又一种行之有效的修复方法。     

潮汕地区1209例唇腭裂患者临床资料分析

目的探讨唇腭裂发生的影响因素。方法统计分析1995～2008年1209例唇腭裂患者的临床资料,分析先天性唇腭裂患病状况与特点。结果唇腭裂患者中,主要以单侧唇裂、单侧唇裂伴腭裂、双侧唇裂伴腭裂为主,分别占27.55%、27.05%和19.69%。除单纯腭裂外,男性发病多于女性。唇腭裂患病左侧比右侧多见。唇腭裂畸形与患者的胎次关系中第一胎、第二胎、第三胎、第四胎、第四胎以上的构成比分别为24.73%、25.14%、21.34%、14.56%、14.23%。母亲中共有193例（15.96%）妊娠前3个月有接触风险因素。不同遗传亲属级别间发生唇腭裂的差异有统计学意义（χ^2=39.063,P〈0.01）。结论唇腭裂的发生可能与遗传、胚胎发育早期的环境因素、药物影响等有关。     

应用螺旋CT重建并测量单侧唇裂和唇腭裂患者畸形外鼻

目的：应用螺旋CT对单侧唇裂和唇腭裂患者畸形鼻进行初步测量分析。方法：采用螺旋CT三维重建后．应用Amira软件对30例单侧唇裂和唇腭裂患者的畸形鼻定点，并进行线距及角度测量。采用SPSS11．5软件包对数据进行配对t检验。结果：对17个标记点共19项测量项目进行测量标记，并对其中7项指标进行了患、健侧比较。结果．单侧唇裂和唇腭裂患者双侧鼻翼发育程度不一致，患侧较健侧发育不全；鼻尖位置偏健侧，导致患侧鼻尖下点到鼻翼基底点的距离大于健侧；鼻梁多偏斜，表现为骨性及软组织共同偏斜；鼻面角小于正常人；患侧鼻孔宽度较健侧大；鼻小柱向健侧偏斜；鼻孔不同程度不对称。结论：应用螺旋CT及重建、测量软件能精确测量外鼻。并可以明确外鼻的畸形程度，患、健侧组织不对称程度及评价手术疗效。     

Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: geometric morphometrics.

OBJECTIVE: To evaluate three-dimensional changes in nasal morphology in patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding (NAM) to correct naso-labio-alveolar deformity. DESIGN: This was a prospective, longitudinal study. Digital stereophotogrammetry was used to capture three-dimensional facial images, and x, y, and z coordinates of 28 nasal landmarks were digitized. SAMPLE: Ten patients with unilateral cleft lip and palate. MAIN OUTCOME MEASURES: Nasal form changes between T1 (age: 28 +/- 2 days, pre-NAM) and T2 (age: 140 +/- 2 days, post-NAM), using conventional measurements and finite-element scaling analysis. RESULTS: Overall nasal changes were statistically different (p < .01), but no linear or curvilinear changes were found. Specifically, relative size increases were found on the noncleft side, involving the upper nose (30%), alar depth (20%), alar dome (30%), columella height (30%), and lateral wall of the nostril (17%). On the cleft side, the following showed a size increase: upper nose (8%), alar dome (5%), columella height (30%), and lateral wall of the nostril (30%). The cleft-side alar curvature, however, showed a large decrease in size (80%), but no changes on the noncleft side were found. Corresponding shape changes and angular changes were also found. CONCLUSIONS: Using NAM, bilateral nasal symmetry in patients with unilateral cleft lip and palate was improved before surgical repair. Furthermore, slight overcorrection of the alar dome on the cleft side using pressure exerted by the nasal stent is indicated to maintain the NAM result.     

Repair of bilateral cleft lip: review, revisions, and reflections

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.     

唇腭裂伴发鼻畸形整体修复术的初步报告

目的:唇腭裂伴发鼻畸形整形修复术是一新颖术式,是缘于以往手术方法注重鼻翼、鼻小柱畸形的整复,而忽略了鼻背鼻尖畸形,以致造成手术修复后鼻外形不够理想,以及手术须在机体部移植组织或应用代用品,而不易为患者与其家属所接受。方法:本手术通过凿断鼻骨及部分上颌骨额突揿压折断使其耸立以抬高鼻背和移植自体鼻中隔软骨以增高鼻尖或鼻翼,一次性完成鼻外形的整体修复。结果:本组施行了3例唇腭裂伴发鼻畸形整体修复术,术后半年随访复查,初期效果满意,未见畸形复发。结论:唇腭裂伴发鼻畸形的整体修复术是依据鼻的正常解剖形态和针对伴发鼻畸形的解剖形态进行设计的,立足于能使鼻畸形取得全面彻底的纠正,和完全利用自体鼻部组织结构,在同一手术区与一次完成的修复方法。通过临床实践证明该方法是可行的,确实能完全纠正整个鼻畸形的优良方法。     

Repair of bilateral complete cleft lip and nasal deformity--state of the art.

OBJECTIVE: Dissatisfaction with the stigmata of repaired bilateral cleft lip has stimulated surgeons to change conventional operative strategies. The old staged labial repairs, one side and later the other, have been replaced by simultaneous closure. For nasal correction, most surgeons no longer believe that the columella is deficient, and thus there is no need to recruit tissue from the lip or nostril sills as a secondary procedure. The columella is concealed in the nose. The new strategy is to construct the columella and nasal tip by anatomic positioning of the alar cartilages and sculpting the investing skin. Furthermore, nasal correction is done at the time of bilateral labial repair and, whenever possible, the alveolar clefts are closed as well. The goal is primary repair of the primary palate. CONCLUSION: Although the principles of synchronous repair of the bilateral complete cleft lip and nasal deformity are established, the techniques continue to evolve. Bilateral nasolabial repair requires continual study of three-dimensional form and fourth-dimensional changes that are normal and altered by the deformity. Every surgeon who lifts a knife to care for these children has an obligation to periodically assess outcome.     

Treatment of the unilateral cleft lip nasal deformity

The lack of tip projection on the affected side of a unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate structural support. A new technique for the correction of the unilateral cleft lip nasal deformity is described. The key components of the technique involve the use of a dorsally angulated unilateral spreader graft on the cleft side and the use of an L-shaped septal graft to provide support to the cleft nasal tip.     

应用Millard法分期修复双侧先天性唇裂

目的：评价Millard法分期修复双侧先天性唇裂的效果。方法：自2005年—2008年尝试用分期手术治疗双侧先天性唇裂12例。以典型Millard法修补一侧裂隙,将双侧唇裂改变成单侧唇裂,4～6个月后再以同样方法修补另一侧裂隙,完成手术治疗。结果：12例患儿均分两期顺利完成手术,伤口一期愈合。由于完全保留了前唇下方唇红组织,术后能形成自然唇珠形态,同时避免了“方块”形人中,从而使修复后的外形更加美观。对于双侧混合性唇裂,分期手术的效果明显优于一次法。结论：分期修复的方法发挥了Millard法的优势,修复效果良好,尤其适合于治疗双侧混合性唇裂。     

单侧唇裂鼻偏曲的分类与治疗

目的 总结单侧唇裂鼻偏曲的分类和相应的外科治疗方法,以提高临床治疗效果.方法 分析2007至2009年在上海交通大学医学院附属第九人民医院口腔医学院唇腭裂治疗中心治疗的单侧唇裂继发鼻畸形176例.根据外鼻锥与面中线的关系,将唇裂鼻偏曲分为3类:骨性鼻偏曲、软骨性鼻偏曲、鼻小叶偏曲,与之对应的手术方法为:骨性鼻锥矫正术、软骨性鼻锥矫正术、鼻小叶矫正术和鼻中隔矫正术.结果 176例患者临床检查无鼻偏曲者93例(53%),伴鼻偏曲畸形者83例(47%).83例鼻偏曲患者中,骨性鼻偏曲8例(10%);软骨性鼻偏曲29例(35%);鼻小叶偏曲46例(55%).以上患者接受相应矫正手术,大部分术后获得满意的效果.结论 单侧唇裂继发鼻畸形患者中近50%可出现鼻偏曲,其中骨性鼻偏曲畸形患者最少,鼻小叶偏曲畸形最多.唇裂鼻偏曲的分类对临床治疗唇裂术后鼻偏曲畸形具有指导意义.     

单侧重度唇裂鼻畸形整复的临床研究

目的:探讨单侧重度唇裂鼻畸形的整复方法。方法:对单侧重度唇裂患者,采用鼻内切口、整改畸形组织、调整定位、整复鼻外形,以达到一期修复鼻部畸形、关闭裂隙的目的。结果:唇裂伴鼻畸形整复手术85例,经13年随访,取得满意效果。结论:鼻内切口整改畸形组织是一种值得推荐的一期修复鼻部畸形关闭裂隙的手术方法。     

Bilateral oblique facial cleft--tissue expansion with primary reconstruction

The oblique facial cleft may present as a cutaneous and/or an osseous cleft, with or without a cleft lip, and with or without a cleft palate. This particular case was born with complete bilateral cutaneous-osseous oblique facial clefts which extended from the oral cavity to the eye sockets with anophthalmia on the right side. The first surgical intervention included a midline nasal skeleton alignment and bilateral cleft lip and alveolus reconstruction. Urinary Foley catheters were used as facial tissue expanders and inserted adjacent to the oblique facial clefts. The second surgical procedure consisted of a partial pyramidal Le Fort II osteotomy for an inferiorly displaced nasal maxillary skeleton and a rotation and advancement of the cheek as a flap for reconstruction of the palpebral cleft and inner canthus.