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Objective@#The cadaveric specimens stained with iodine-potassium iodide can show the fine structure of muscles by Micro-CT scanning. A specimen with cleft palate was scanned using this technique to explore the relationship between the muscle fibers of pharyngeal muscles in order to guide the muscle reconstruction in cleft palate repair, so as to understand the lingual pathology secondary to cleft palate.@*Methods@#One unclaimed 28-week aborted stillbirth, diagnosed as Ⅱ-degree cleft palate, was dissected.The anatomic structure between orbital floor plane and mouth bottom plane was saved, and soaked in 4% for maldehyde for 8 hours. Thereafter, the subject was soaked in 3.75% iodine-potassium iodide for 7 days for staining. The stained specimens were scanned with Micro-CT. The muscle fibers were drawn in the exported DICOM images, for three-dimensional muscle reconstruction.@*Results@#The main muscles of velopharynx were located in the tomographic image and the three-dimensional reconstructed model, including: the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle, the palatoglossus muscle, and the upper part of the superior pharyngeal constrictor. Some local anatomical features of the muscles were also found: (1)The tensor velipalatini has a branch ended at the lateral pharyngeal wall.(2)The superior pharyngeal constrictor has multiple connections with the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle.(3)There was no obvious muscle fiber crossing between the internal muscles of the cleft palate. The muscle of uvula was not found either.@*Conclusions@#With the application of high-resolution Micro-CT technology, new branches of pharyngeal muscles and crossings of muscles can be recognized. In the cleft palate specimen, the main functional muscles of pharyngeal are mainly associated with superior pharyngeal constrictor. The muscles in the palate and the pharynx are interrelated and form a three-dimensional " velopharyngeal muscle complex" .
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Objective@#This study is to repair nostril sill deformity in the cleft lip patients by reconstructing the first auxiliary muscle tension line group and to assess the therapeutic outcome.@*Methods@#437 cleft lip patients with nostril sill deformity underwent the surgery from January 1, 2012 to November 1, 2016.They were treated using the technique of first auxiliary muscle tension line group reconstruction to repair the deformity. Aesthetic correction evaluations were rated by the GAIS. Random digit was used to randomly select 24 patients during the follow-up for three-dimensional measurement and analysis. The preoperative and postoperative symmetry of the nostril sills were evaluated by paired t test.@*Results@#Mucosal ischemia or wound infection occurred in 11 cases, left obvious scar on the nostril floor. Surgical incisions of the other patients were primary healing. After 6 months to 3 years follow up, GAIS questionnaires of 378 patients demonstrated that 84% patients reported great or moderate improvement of nostril sills. Three-dimensional measurements of 24 patients suggested that there were no significant differences of the nostril sill and the nasal ala between the cleft side and the normal side.@*Conclusions@#First auxiliary tension line group reconstruction, which is to restore biomechanical balance rather than merely increase muscle volume, is an effective method of nostril sill repair in the cleft lip patients. Post-operatively, the patients achieved a stable and natural nostril sill, a middle columella, as well as a narrowed nasal ala.
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<p><b>OBJECTIVE</b>To classify the patients with cleft lip and palate who need orthognathic surgery and to propose the corresponding operations.</p><p><b>METHODS</b>From January 2005 to May 2015, 121 patients with cleft lip and palate diagnosed as maxillary retrusion were treated by orthognathic surgery. Inclusion criteriar: (1) male aged over 16, female aged over 14; (2) diagnosed as non-syndromic cleft lip and palate without systemic disease and other genetic diseases; (3) without previous orthodontic and orthognathic treatment; (4) having no other craniofacial malformation. Maxillary features and repaired types were recorded.</p><p><b>RESULTS</b>93 patients were included and divided into two categories depended on the dental crowding. Class I: the teeth quantity and bone quantity is coordinated, space analysis ≤ 4 mm (mild dental crowding). The forward distance of maxillary less than 6 mm was defined as Class I a (36 cases) more than 6 mm as Class I b (28 cases). Class II: the teeth quantity and bone quantity is not coordinated, space analysis > 4 mm ( moderate or severe dental crowding). After the simulation of distraction osteogenesis, the anterior crossbite was corrected defined as Class II a (23 cases), not corrected defined as Class II b (6 cases). Class I a were corrected by conventional orthognathic surgery. While Class I b were corrected by Le Fort I maxillary advancement using distraction osteogenesis. Class II a were repaired just by anterior maxillary distraction. While Class II b need to combine conventional orthognathic surgery with anterior maxillary distraction. All the patients were satisfied with the treatment effect.</p><p><b>CONCLUSIONS</b>The patients of cleft lip and palate with maxillary retrusion who need orthognathic surgery can be classified as the method mentioned above, and then choose the appropriate operations.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Cleft Lip , Cleft Palate , Maxilla , Osteogenesis, Distraction , Osteotomy, Le Fort , Retrognathia , Classification , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the nasolabial muscle anatomy and biomechanical characteristics.</p><p><b>METHODS</b>Micro-computed tomography scan was performed in 8 cases of spontaneous abortion fetus lip nasal specimens to construct a three-dimensional model. The nasolabial muscle structure was analyzed using Mimics software. The three-dimensional configuration model of nasolabial muscle was established based on local anatomy and tissue section, and compared with tissue section. Three dimensional finite element analysis was performed on lip nasal muscle related biomechanics and surface deformation in Application verification was carried out in 263 cases of microform cleft lip surgery.</p><p><b>RESULTS</b>There was close relationship between nasolabial muscle. The nasolabial muscle tension system was constituted, based on which a new cleft lip repair surgery was designed and satisfied results were achieved.</p><p><b>CONCLUSIONS</b>There is close relationship among nasolabial muscle in anatomy, histology and biomechanics. To obtain better effect, cleft lip repair should be performed on the basis of recovering muscle tension system.</p>