Muscles reposition in correction of nasal deformity after unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effective method for correction of nasal deformity after unilateral cleft lip.</p><p><b>METHODS</b>50 cases with secondary nasal deformity after unilateral cleft lip were retrospectively analyzed. All the patients underwent nasal and lip muscle reposition operation to restore the symmetry of nasal alar.</p><p><b>RESULTS</b>The nasal deformity was greatly improved in all the 50 cases. The malposition of nasal column and nasal alar was corrected. The symmetry was markedly improved. The measurement before and after operation showed significant difference ( P<0.05).</p><p><b>CONCLUSIONS</b>The reasons of secondary nasal deformity after unilateral cleft lip are complicated. The muscle reposition operation can effectively improve the deformity.</p>

A new modified forked flap and a reverse V shaped flap for secondary correction of bilateral cleft lip nasal deformities / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The columella, nasal tip, lip relationship in the bilateral cleft lip nasal deformity remains a great challenge for plastic surgeon. An esthetically satisfying result is difficult to obtain. A subset of patients with bilateral cleft lip nasal deformity still require columellar lengthening and nasal correction and philtrial construction. This study aimed to provide a new method based on the forked flap to improve the final appearance of these patients.</p><p><b>METHODS</b>A technique to correct this deformity is described. This consists of (1) a newly modified forked flap including the orbicularis oris muscle and nasalis muscle along the whole flap for columellar lengthening, (2) a reverse V shaped flap from the lower portion of the columella and the prolabium for normal size phitrum construction, (3) inserting the vermilion portion of the forked flap and advancing the nasal floor medially and anteriorly to lengthen and maintain the nasal septum side of the columella for proper tip positioning, (4) open rhinoplasty, allowing definitive repositioning of the lower lateral cartilages, (5) reconstruction of the orbicularis orismuscle as required, and (6) the flaring nostril floor advancing medially and constructing the sill.</p><p><b>RESULTS</b>This technique was applied to 15 cases of secondary bilateral cleft lip nasal deformity. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the height of the prolabium was added with normal size philtrial dimensions.</p><p><b>CONCLUSIONS</b>This method makes maximum use of the tissue containing the scar in the lip and limits tissues in the lower portion of the columella and the prolabium for adequate columella elongation and reconstruction with normal size philtrial dimensions. It is a very reasonable and useful method in correction of secondary bilateral cleft lip nasal deformities.</p>

Correction of secondary deformity of unilateral cleft lip with refined anatomic repair in orbicularis oris muscle / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the functional repair of secondary deformity of unilateral cleft lip.</p><p><b>METHODS</b>The nasal branch, nasolabial branch, and labial branch of orbicularis oris muscle were dissected and repositioned precisely to correct the secondary deformity of unilateral cleft lip.</p><p><b>RESULTS</b>96 patients were treated successfully with this method during Jan. 2005 to Oct. 2008. Good cosmetic and functional results were achieved. 85 cases were followed up for 3 months to 5 years with a satisfactory rate of 94.1% (80/85 cases).</p><p><b>CONCLUSIONS</b>The application of refined anatomy and precise reposition in orbicularis oris muscle is important to ensure therapeutic effect in patients with secondary deformity of unilateral cleft lip.</p>

Trilobate technique, a new principal to repair cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop a new method for reparation of cleft lip, and to evoke more colleagues for advance practices and study, in order to determine her indication and contraindication as soon as possible.</p><p><b>METHODS</b>48 cases were included into this study. Trilobate flap were designed in floor of nose and lip area in cleft side, rotate two of the three flaps upwards, respectively to elevate the tip of nose, and to reconstruct the floor of nose. As for the left flap, it was derived transversally to opposing side, sutured with the flap of non-cleft-side.</p><p><b>RESULTS</b>With this technique, less tissue was lost, better vertical lengthening and good formed cuspids-bow was achieved, and the scar was a parallel line being symmetry to the philtrum column opposite. Meanwhile, because the tension was mainly located in the area where there was no mini flaps, the blood supply was good enough, rarely occur any necrosis in the tip of flaps. All cases in this study obtained perfect healing, with good appearance at nostrils and floor of nose.</p><p><b>CONCLUSIONS</b>In use of the method of trilobate flap, we can draw down the peak of the cuspids bow effectually, hence avoid the addition cut in the lower part of the lip, decrease the scar on skin, as well as nice reconstruction of floor of nose, philtrum column and nostril. Because lack of long term study, we evoke more colleagues for cooperation in advance study.</p>

Unilateral buccinator myomucosal island flap with double opposing Z-plasty for wider palatal cleft repair / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a method to repair larger cleft palate and lengthen soft palate without oral palate raw surface and scar formation, reduce the effect on maxilla and dental arch development.</p><p><b>METHODS</b>A modified double opposing Z-plasty was used to lengthen soft palate and the nasal palate was closed by using large turn-over mucoperiosteal flaps on the oral surface of the junction of the hard palate and soft palate, oral raw surface on the palate was closed by a buccal myomucosal island flap.</p><p><b>RESULTS</b>Thirty-six palates have been repaired by this procedure, all of which had satisfactory results without flap necrosis, infection, difficulties in opening mouth and facial nerve injury except two post-operative fistulas. Eight patients were followed up and all display complete velopharyngeal closure.</p><p><b>CONCLUSIONS</b>Using unilateral buccinator myomucosal island flap with double opposing Z-plasty to repair wider palatal cleft can get a satisfactory soft palate lengthening. At the same time it can avoid bone surface exposing and scar formation; it is a safe and reliable procedure.</p>

Buccal musculomucosal flap for reconstruction of wide vermilion and orbicularis oils muscle defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the reconstruction of wide vermilion and orbicularis oris muscle defect with satisfactory outcome of aesthetics, sensation, and function.</p><p><b>METHODS</b>The buccal musculomucosal flap based on the anterior buccal branches of the facial artery was used to reconstruct wide defect of vermilion and orbicularis oris muscle on upper or lower lip.</p><p><b>RESULTS</b>7 patients were treated. 5 cases had no postoperative complication. Partial mucosal necrosis on the tip of the flaps happened in 2 cases, but the underlying muscle survived and was re-mucosalized spontaneously. No other complication was observed. The sensation of cold, heat and touch could be detected on the first postoperative day. Electromyographic and electron microscopic studies confirmed innervation of the muscle in the flap.</p><p><b>CONCLUSIONS</b>The buccal musculomucosal flap is a reliable reconstruction option for wide defect of vermilion and orbicularis oris muscle which can' t be reconstructed with conventional method. Satisfactory aesthetic and functional results can be achieved with the buccal musculomucosal flap.</p>

Role of MR imaging on the diagnosis of velopharyngeal insufficiency preoperatively / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and actuality of MR imaging on diagnosis and evaluation of velopharyngeal insufficiency preoperatively.</p><p><b>METHODS</b>Since 2002, six patients with velopharyngeal insufficiency were examined with MRI using midsagittal, coronal, and axial images, contrast with radiography, to affirm configuration and movements of soft palate, posterior and lateral pharyngeal walls, and velopharyngeal opening for the choices of following surgeries.</p><p><b>RESULTS</b>MRI visualizes directly and measures objectively the shorter soft palate, confined movements of soft palate, lateral or/and posterior pharyngeal wall, and deeper and enlarged velopharyngeal opening, which were coincided with clinical symptoms and affirmed by observations in the following operations, surpassing radiography.</p><p><b>CONCLUSIONS</b>MRI is effective, actual, and uninvasive in imaging and measuring the velopharyngeal insufficiency, thus has a potential role in investigation and planning surgical repairs.</p>

The influence of the osteogenesis in cleft palate after palatal surgery to the transverse growth of dental occlusion / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To compare the transverse growth of the dental cast following palatal surgery with or without osteogenesis in palatal gap.</p><p><b>METHODS</b>31 patients at 13 - 28 years old with repaired palate were selected to take the dental cast, the width of the dental arch, alveolar base and the matching degree between arches were measured and the average was calculated. After the length of the bone bridge in palate was measured through CT scan, the relationship between the osteogenesis in palatal gap and the transfers growth of dental cast was studied.</p><p><b>RESULTS</b>The critical length of the bone regeneration in palatal gap to affect the dental growth is 4 mm, mean while the sufficient length is 8 mm. The group of sufficient bone bridge has a better development in both the width of dental alveolar base and that of dental arch and the matching degree than the group of unsurficience. And this intendance was more obvious in premolar region than in molar region.</p><p><b>CONCLUSIONS</b>The osteogenesis in palatal gap following palatal surgery can strongly support the transfers growth in the width of dental arch, the width of alveolar base and the matching degree between upper and lower dental arch.</p>

Bone regeneration on hard palate after palatal surgery on cleft palate and the relative factors / 中华整形外科杂志

<p><b>OBJECTIVE</b>Attending to observe the bony healing on hard palate after palatal repair, and to discuss the factors affecting on it.</p><p><b>METHODS</b>52 patients with repaired cleft palate over 5 years postoperatively were examined, the CT scan of head was taken. The incidence of the bone regeneration among the patients examined was calculated, the position and quality of bone tissue were measured according to the CT images. After all, analysis was applied to evaluate the factors affecting on the bone tissue formation.</p><p><b>RESULTS</b>Formation of bone bridge was found in the 37 cleft gaps out of 52 patients (71%), the ratio of the sex among the patients who had bone bridge was 1:1, there was no obvious difference between unilateral and bilateral cleft palate. Considering the operation age with the bone formation, the highest percentage of bone bridge formation fell into the group of 4-7 years old, and the most occurring region were in premolar and anterior part of molar area.</p><p><b>CONCLUSION</b>There could be bony healing(regeneration bone tissue RBT) after palatal repair on cleft palate patients. The operation age could be an important affecting factor to RBT, but the sex and the clinical type of cleft palate make no difference on the bone tissue formation.</p>