Reconstruction of philtrum using Muscle Tension Lines Group in microform cleft lip / 中华整形外科杂志

Objective@#This study is to investigate the effectiveness of philtrum repairment for-microform cleft lip, using muscle tension line group reconstruction.@*Methods@#This is a retrospective study of 19 consecutively primary microform cleft lip repairment patients, from January 2015 to December 2017. All the patients were provided muscle tension line reconstruction (group 1) or traditional muscle repairment by horizontal mattress sutures (group 2). The philtral ridge and dimple were evaluated by scores. The statistical analyses were performed using unpaired t-test by Prism 6.0 software.@*Results@#The philtral ridge score was higher in group 1 than group 2 (4.15±0.56 vs. 2.73±0.32, P<0.01). The philtral dimple score of group 1 increased either, when compared with group 2 (2.36±0.50 vs.1.45±0.28, P=0.0004).@*Conclusions@#Functional reconstruction of philtrum, using muscle tension line group repair, has satisfactory results in philtral ridge and philtral dimple.

Microforma de fisura labial superior incompleta unilateral: reporte de un caso / Microform of unilateral incomplete upper cleft lip: report of a case

La microforma de fisura labial es una expresión de la fisura labial superior incompleta que se caracteriza por un surco o depresión cutáneomuscular a lo largo del margen del filtrum, asimetría o discontinuidad del margen mucocutáneo a nivel del pico del arco de Cupido, discontinuidad de la porción superior del músculo orbicular de la boca y deformidad menor del ala nasal. Es una condición que por su aparente poca gravedad y aparente fácil reparación, así como por su inusual presentación clínica, los reportes literarios sobre ella son escasos. Se presenta una revisión bibliográfica al respecto y se comunica un caso clínico como aporte a la literatura (AU)

The microform cleft lip is an expression of incomplete superior cleft lip is characterized by a groove or depression cutaneous and muscular along the margins of the philtrum, asymmetry or discontinuity mucocutaneous margin at the peak of Cupid's bow, discontinuity in the upper portion of the orbicularis oris muscle and minor deformity of the nasal ala. It is a condition for its apparent low gravity and apparent easy to repair as well as for its unusual clinical presentation, literature reports are scarce. We present a literature review and communicate about a case as a contribution to literature (AU)

A minimally skin incision for unilateral microform cleft lip repair / 中华医学美学美容杂志

Objective To introduce a surgical procedure resulting in less scars for unilateral microform cleft lip.Methods A Z-plasty incision was designed at suffered agger nasi,and then subcutaneours dissection of suffered upper lip and basis nasi was performed.Releasing suffered alar nasi base from maxillary bone by partly severing the mesculus compressor naris,an orbicularis oculi flap was formed and fixed to the hypodermis of columella base for advancing to superior medial position and overlaying orbicularis oculi.The labial frenulum extension and vermillion submucoustissue flap plicature for filling incisura were carried out to correct the deformitiy of vermillion incisura.Results After 6-18 months follow-up,the wounds of 7 cases (aged 7-19 years) healed at the first grade.The deformity of unilateral subcutaneous celft lip,such as the agger nasi and vermillion incisura,widened nostril,and deficient abial height,was significantly improved.Conclusions Unilateral subcutaneous celft lip could be satisfactorily reconstructed by the surgical technique consisting of Z-plasty incision at agger nasi,orbicularis oculi flap advancing,labial frenulum extension and vermillion submucous tissue flap plicature,with less scar formation.

Ultrastructural Characteristics of the Orbicularis Oris Muscle in the Microform Cleft Lip

RecentIy, increasing emphasis has been placed on the histochemical and ultrastructural characteristics of the muscle in the cleft lip. Schendelet al and Cho et al demonstrated a non-neurogenic muscle atrophy and mitochondrial myopathy, and Raposio examined an increased inflammatory reaction, but no mitochondrial abnormalities of the cleft lip muscle. However, no study has focused on the ultrastructure of the microform cleft lip muscle. Eleven muscle specimens were obtained from the microform cleft lip patients at the time of primary repair from Jun.1997 to Aug.1998 and they were submitted to histologic and histochemical examinations as well as electron microscopy. A non-neurogenic muscle atrophy was seen on HE stain. Modified Gomori trichrome stain revealed red granularity of the muscle fibers, suggesting an increase in mitochondrial activity, however, no ragged-red fibers, a typical sign of mitochondrial myopathy, was found. Electron microscopy revealed atrophy, disarray, and focal loss of myofibrils, dilated sarcoplasmic reticulum with glycogen deposit, and interstitial fibrosis. However, the mitochondrial morphology was well preserved with an increase of the number of the mitochondria which might be secondary change to muscle degeneration. In conclusion, ultrastructural characteristics of the orbicularis oris muscle in the microform cleft lip is non-neurogenic muscle atrophy without mitochondrial myopathy which is controversial in the complete cleft lip.

Reconstruction of Proximal Nasal and Medial Canthal defects with Island Composite Glabellar Flaps

PURPOSE: It is difficult to reconstruct nasal root defects because of complicated anatomy and function of the nose and eyelids, donor site morbidities, and aesthetic results. So, choosing suitable one of various reconstructive methods is very important and difficult. We report the island composite glabellar flap as an alternative reconstructive method of proximal nasal and medial canthal area. METHODS: From May 2005 to January 2007, we performed 8 cases of the island composite glabellar flap to reconstruct the defects in proximal nasal and medial canthal area after resection of skin cancer. The flap was elevated with the nasal skin, subcutaneous fat tissue, and procerus muscle based on the dorsal nasal branch of the angular artery. The flap donor site was closed in a V-Y fashion. RESULTS: This result was satisfactory in point of color, texture and donor site scar. There was no major complication such as wound disruption, hematoma, and atrophy of flap. But flap bulkiness was observed in one case. CONCLUSIONS: This island composite glabellar flap has several advantages in reconstruction of proximal nasal and medial canthal defects. This flap has reliable vascular pedicle and can be moved to multiple direction and has more mobility than other local flaps. Also, aesthetic outcome of the donor and the recipient site was good. We believe that this flap is a useful technique as a treatment of proximal nasal and medial canthal defects

Philtrum Formation in Secondary Unilateral Cleft Lip and Microform Cleft Lip Using Vertical Interdigitation of the Orbicularis Oris Muscle

For patients who have undergone cleft lip surgery, the construction of the philtrum is crucial for restoring a normal appearance of the upper lip. Thirteen patients with unilateral secondary cleft lip deformity and 12 patients with microform cleft lip were treated for the creation of a philtral column between January of 1998 and October of 2002. Fifteen patients were male and 10 patients were female with an age ranges from 6 months to 43 years old. In patients with the depressed philtral column in secondary cleft lip deformity, external approach was used. The scar on the philtral column is excised and a full-thickness incision is made down to the orbicularis oris muscle and mucosa. The medial and lateral muscle flaps are exposed and split into two leaves. The two leaves of each muscle flap are sutured together to create a vertical interdigitation. Any excess skin is not excised but rather closed with 6-0 nylon. In patients with microform cleft lip, vertical interdigitation of the orbicularis oris was performed through the intraoral incision to avoid external scarring. The follow-up period ranged from 6 months to three years, with an average of 14 months. Among the 13 patients with secondary cleft lip deformity, 10 patients were satisfied with their surgical results. Two had fair results. One patient experienced a widening of the scar and no improvement in the philtral column. A possible cause for the lack of improvement in one patient was a partial disruption of the interdigitated muscle before wound healing. On the other hand, all patients with microform cleft lip were satisfied with their surgical results. In conclusion, the advantage of this procedure includes the creation of an anatomically natural philtrum through preserving the continuity and function of the muscle, sufficient augmentation of the philtral column by the vertical interdigitation of the muscle, relief of skin tension, and no donor-site morbidity. In addition, in microform cleft lip, the external visible scar was avoidable through the intraoral incision.

Surgical Correction of Microform Cleft Lip by Small Triangular Flap

Cleft lip is one of the most common major facial malformation. The defect of the midline tissue on the upper lip is due to failure of the contact and fusion between mesenchymal tissues of the lip. Microform cleft lip is defined as the cleft of the lip with the minor degree of the deformity on the lip and the nose. The hallmarks of the microform cleft lip are a small notching of the vermilion, a vertical congenital fibrous band extending from the vermilion to the nostril floor, and a displaced alar cartilage on the cleft side. The surgical methods of microform cleft lip include Rose-Thomson straight line closure and Millard Rotation- advancement repair. Although those methods repaired the functional impairment effectively, they failed to achieve the cosmetic improvement because of the long incision scar on the upper lip. The authors applied Tennison's small triangular flap to the microform cleft lips of the 10 patients from July 1998 to January 2001. We excised the scar on the notch of the vermilion with minimal incision using Tennison's small triangular flap and repaired the discontinuity of orbicularis oris musculture. The asymmetric nostrils were also corrected appropriately. We followed up each case with constant intervals and could get good results esthetically without shortening of the upper lip and the contracture of the scar band.

Classification and Operation of Microform Cleft Lip

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.