摘要
目的:以Millard术式为代表的旋转推进瓣唇裂基本手术方法,术后远期效果受到术者、术式、畸形程度等多因素的影响,手术效果难以恒定。本文介绍一种新的个体化唇裂手术方法,以期解决以上问题。方法:唇裂患者27例,平均手术年龄4.6个月,类型包括单侧不完全性唇裂和单侧完全性唇裂。患侧鼻小柱点依据健侧鼻孔大小而定,避免患侧鼻底下的切口,患侧裂隙唇部切口线重建后形成双侧对称结构,唇部各解剖标志自然状态下复位。结果:整个上唇解剖标志自然,上下唇比例协调,组织充足;人中凹存在,皮肤瘢痕明显减少;唇沟部分自然并与邻区相连,同时为二期手术创造了良好条件,利于再次手术;另外,本组患者中无上唇过紧现象,手术效果满意。结论:研究提示依据新的定点和设计提出的个体化手术方案,是一种修复单侧唇裂的新方法,对于单侧唇裂不同畸形程度的患者,均可适用。
Objective： The basic principle of primary cleft lip reparation has been built according to tissue rotation and advancement concept by Millard. Retrospective analysis showed that the reparative outcome remains inconstancy related with many factors： operator skills, technique emphasis, variation of deformities, etc. In the present study, we recommended a new cheilorrhaphy individualized design on primary repair. Methods： We present a retrospective review of 27 patients with unilateral cleft lip, referred to the Craniofacial-cleft department of oral and maxillofacial surgery of Shanghai ninth People＇s hospital from Januai.＇y of 2004 to December of 2007.All cases, including complete unilateral cleft lip, noncomplete unilateral cleft lip and occult cleft, were reconstructed by the new approach and were assessed with aesthetical protocol. The major surgical techniques included the reconstruction of apertura narium with individualized columella landmark, affected side reconstruction of lip with no incision on basis nasi and affected phihrum incision line. The rotation and advancement of all landmarkers were reestablished using sufficient lip mucosa reservation and orbicularis otis muscle functional repositioning. Results： All the cases experienced individual surgical approaches. The average of follow-up was 15 months （range from 1 to 40 months）. All the patients presented natural labial groove between affected and unaffected side. The reconstructed philtrum looked as almost as a normal philtrum. A symmetry outcome of upper and lower lip and camouflage scars were manifested even though primary nasal repair was not included. The aesthetic results could also contribute to secondary, repair if needed.Conclusion： Unilateral cleft lip always accompanied with individualized deformities. We consider these revised landmarkers and incisions of rotation and advancement in this new method are useful and effective in repairing primary unilateral cleft lip, and emphasize individualized anatomic structures of deformities, including muscles and soft tissue,which plays an essential role in designing and long term aesthetic outcomes.
出处
《口腔颌面外科杂志》
CAS
2009年第3期172-175,共4页
Journal of Oral and Maxillofacial Surgery
基金
上海市教育委员会科学基金曙光计划资助项目(2000SG41)
上海市重点学科(优势学科)建设项目(Y0203)
上海市科学技术委员会资助项目(08DZ2271100)
关键词
单侧唇裂
一期修复术
个体化设计
unilateral cleft lip
primary repair
individualized surgical design
