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。

Management of secondary nasolabial deformities after bilateral cleft lip repair

OBJECTIVE: To evaluate the method to correct the seconary nasolabial deformities after the surgical treatment in the patients with bilateral cleft lip. METHODS: From January 2000 to June 2003, forty patients with secondary deformities following repair of bilateral cleft lip were treated with a combined treatment procedures. AU of the forty cases underwent the following preoperative treatments: alveolar bone graft in 28 cases, preoperative orthodontics in 22 cases, prosthodontics in 20 cases and orthognathic surgery or distraction osteogenesis treatment in 20 cases, respectively. In order to improve the enlongation of nasal column, reconstruction of Cupid's bow, philtrum and correction procedures, continuous incision was made from the vermilion in median of the upper lip, the scar edge, the bilateral sides of the nasal column to the inner side of the nose, even extending the bilateral incision to nasolabial groove and nostril fundus. RESULTS: Forty patients were got the follow-ups for 3 months to 3.5 years and the satisfactory rate reached 95%. CONCLUSION: It is natural to emphasize the setting up of odontomaxillary frame and then utilize the surgical procedure to correct the secondary nasolabial parenchyma deformities. The method could be feasible and reliable for the correction of the secondary nasolabial parenchyma deformities after bilateral cleft lip repair.