Classification of nasal tip hypertrophy and treatment methods / 中华整形外科杂志

<p><b>OBJECTIVE</b>To classify the nasal tip hypertrophy according to the anatomic characters, so as to select the proper treatment methods.</p><p><b>METHODS</b>From Jan. 2010 to Mar. 2012, 92 cases (aged 21-46 years,average 29 years old) with nasal tip hypertrophy were classified as soft tissue hypertrophy, the alar cartilage hypertrophy, separation of alar cartilage, secondary tip hypertrophy after operation, and compound hypertrophy. Treatment methods were selected according to the hypertrophy type, including soft tissue thinning hy medicine or operation, alar cartilage trimming and remodeling, autogenous ear and nasal septal cartilage grafts for elongation or remodeling of nasal tip or columella.</p><p><b>RESULTS</b>The follow-up period was 3 months to one year. The nasal tip hypertrophy was corrected obviously with a natural and harmonious appearance. The results were evaluated hy patients as perfect in 59 cases, good in 26 cases and medium in 7 cases.</p><p><b>CONCLUSION</b>Satisfactory results can he achieved for the nasal tip hypertrophy with appropriate methods according to the anatomic classification.</p>

Experience of midfacial distraction osteogenesis in upper airway stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of upper airway stenosis after Le Fort III osteotomy and midfacial distraction osteogenesis (DO).</p><p><b>METHODS</b>Eleven cases (age, 5-16 yrs) with severe midface dysostosis complicated with exophthalmos, anterior crossbite and upper airway stenosis were treated by using Le Fort III osteotomy and midfacial DO from August 2000 to February 2007. The 3D reconstruction of the upper-airway from CT data was used to evaluate the upper airway volume before and after the operation. And meanwhile polysomnography was carried out to demonstrate the upper airway functional changes.</p><p><b>RESULTS</b>There was a 64.3% mean increase [mean, (9.13 +/- 6.94) ml, P < 0.05] in upper airway volume in the 11 cases after the operations. It showed that there was significant improvements in the indexes of polysomnography after the operations, such as apnea and hypopnea index, average SaO2, minimum oxygen saturation and snore index.</p><p><b>CONCLUSIONS</b>The Le Fort III osteotomy and midfacial distraction osteogenesis can efficiently relieve the symptoms of upper-airway stenosis in severe midfacial dysostosis.</p>

Changes of different section area at different parts of upper-airway after Le Fort III osteotomy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effects of Le Fort III osteotomy and midface distraction osteogenesis (DO) on the upper-airway narrow.</p><p><b>METHODS</b>Since 2000, 11 cases (10 cases of Crouzon syndrome and 1 case of Apert syndrome) with severe midface deficiency were treated with Le Fort III osteotomy and midface DO. The section area of different parts of upper-airway were tested by computer assistants image measurement preoperatively and postoperatively. Some patients received sleep function monitoring.</p><p><b>RESULTS</b>The face appearance and the function of upper-airway improved significantly after Le Fort III osteotomy and Midface DO. The section area at the level of posterior nasal spine and uvula increased obviously after treatment (P < 0.05), however the section area at the level of epiglottis and separation between airway and esophagus were not obviously enlarged (P > 0.05).</p><p><b>CONCLUSIONS</b>Midface DO after Le Fort III osteotomy can effectively improve the upper-airway narrow, especially the upper part from uvula.</p>

Surgical correction of craniofacial dysostosis with midface distraction osteotogenesis / 中华整形外科杂志

<p><b>OBJECTIVE</b>Correction of craniofacial dysostosis with midface distraction osteotogenesis.</p><p><b>METHODS</b>Le Fort III osteotomy has been employed through coronal route on patients with midface craniofacial dysostosis such as Crouzon and Apert syndrome. Then a REDII distraction device was set up, and the device bars directed. The distraction begins 6.4 days after the surgery, with a rate of 1 mm per day. When midface approaching the right position, i.e. an slightly over correction of occlusion is reached, the distraction stops and the device is held for the next 2-4 months.</p><p><b>RESULTS</b>There are 8 cases completed all the therapy with an average age of 11.9 years old. The midface had been moved averagely 9.7 mm forwards and 1.6 mm downwards. The features had been improved obviously and the occlusions reach nearly normal. The exophthalmos reduced from 20.3 mm to 11.9 mm. In cephalometry, SNA was averagely enlarged 9 degrees, and ANB enlarged 8.8 degrees. The snore during sleeping was also improved in 87.5% cases. No serious complication had occurred except minor one such as 1 case of seroma and 1 case of infection around pin on scalp. According to 5 months averagely follow-up, there is no recurrence in our list.</p><p><b>CONCLUSIONS</b>Midface distraction osteotogenesis is propitious to teenage or severe cases of craniofacial dysostosis.</p>

Surgical correction of craniofacial dysostosis with midface distraction osteogenesis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of distraction osteogenesis on correction of craniofacial dysostosis.</p><p><b>METHODS</b>Le Fort III osteotomy was applied through coronal route on patients with craniofacial dysostosis such as Crouzon and Apert syndrome. The procedures included disconnecting the skeletal midface from base of cranium, setting up a RED II distraction device, and directing the device bars. The distraction was started 5 days after the surgery, with a rate of 1 mm forward per day. When midface approaching the right position, i.e. a slightly over correction of occlusion was reached, stopped distraction and kept the device for 2 - 4 months.</p><p><b>RESULTS</b>Eight cases completed all the therapy. The average blood lose was 300 ml and the average operation time was 3.5 hours. The midface had been moved averagely 9 mm forwardly and 1.5 mm downwards. The features had been improved obviously and the occlusion reached nearly normal. No serious complications occurred except for 1 case of seroma and 1 case of infection around pin on scalp. No recurrence was found in the 5 months of follow-up.</p><p><b>CONCLUSIONS</b>Midface distraction osteogenesis is propitious to teenage or severe cases of craniofacial dysostosis.</p>

The effect of insulin-like growth factor 1 on the fusion of cranial suture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of insulin-like growth factor 1 for the bone induction and the regulation for the fusion of the sagittal cranial sutures.</p><p><b>METHODS</b>The cells, derived from cranial sutures in the newborn SD rats and the sagittal suture from the mice, were cultured with a serum-free medium and treated with and without insulin-like growth factor 1. The osteoblast phetotypes (osteocalcin, alkaline, osteoponcin and type-1 collagen) were measured with the RT-PCR and ELISA, and the explanted sagittal sutures were then evaluated under light microscopy.</p><p><b>RESULTS</b>The cells, treated with the insulin-like growth factor 1, significantly produced more osteocalcin, alkaline, osteoponcin and type-1 collagen than those without insulin-like growth factor 1. The fusion of the sagittal suture explants will delay till to 30 days when it was not treated with IGF1. However, in the group with IGF1 the fusion was observed to start in 8 days, and a small amount of the sagittal suture fusion was found at the 20th day while a large amount was at the 30th day.</p><p><b>CONCLUSION</b>The IGF1 has a direct effect on the fusion of cranial suture due to enhancing bone induction of cranial suture cell.</p>

Analysis of the Millard method for unilateral cleft lip repair / 中华整形外科杂志

<p><b>OBJECTIVE</b>To analyze and describe the advantages and disadvantages of the Millard repair in the unilateral cleft lip (UCL).</p><p><b>METHODS</b>In 30 patients with UCL undergoing the cleft lip repair with the Millard I or II method, the vermilion was repaired by a modified method with a triangle flap, while the alar cartilage reposition was performed.</p><p><b>RESULTS</b>Postoperative follow-up of 6-12 months revealed the good results with invisible scar, good preservation of philtrum dimple and column, full vermilion and lengthened columella, good alar cartilage reposition.</p><p><b>CONCLUSION</b>The Millard method is good for UCL repair. The modified technique with a triangle flap on the vermilion edge can overcome Millard's disadvantages. The anatomic reposition of the affected alar cartilage by blunt dissection at the first stage is suitable for the oriental.</p>