改良皮肤切口及口轮匝肌解剖学重建在先天性双侧唇裂修复术中的应用

Improved incision and anatomical reconstruction of orbicularis oris in the repair of bilateral clef lip

目的探讨减轻先天性双侧唇裂修复术后鼻唇畸形的方：法。方法对45例8个月一35岁的双侧唇裂一期、二期患者，采用原长法或加长法修复双侧唇裂，术中采用改良皮肤切口（绕鼻翼最外点的鼻翼外侧沟附加皮肤切口；对于唇高不对称患者应用“会圆术”原理数字化精确设计弧线切口；前唇两侧纵行切口），并借助手术放大镜对口轮匝肌进行解剖学重建。结果45例术后切口均I期愈合，口轮匝肌运动时上唇各部分协调一致，唇鼻静态、动态外形满意。结论先天性双侧唇裂修复术中，采用改良皮肤切及口轮匝肌解剖学重建术可使患者获得满意的鼻唇外形及功能效果。

Objective To observe the improved incision design and anatomical reconstruct of orbieularis oris in repairing of bilateral cleft lip. Methods Patients who had bilateral cleft lip Ⅰor Ⅱ and whose age ranged from 8 months to 35 years old were chosen, and then according patiens′age and their deformed degree, rectilinear or prolate operation were adopt. Under outsole of ala nasi, nasolabial muscle bundle which was abmornal cohere at edge of nostrils and apertura piriformis was cut off. To rectilinear design, the incision which wraped the outsole of ala nasi was chosen. To patients whose lip heights were not symmetry, we designed a are incision precisely according to the “huiyuan theory”. Orbicularis oris was reconstruction under operating magnifier. Results Every postoperative incisal opening could heal in one-stage, all parts of superior lip could coordinate when the orbicular muscles moved. The up lip and contours of nasal quiet state and its dynamic state were satisfactory. Conclusion It can make patients get excellent nasolabial profile and function through restituting orbicularis oris of bilateral cleft lip in anatomy and improved incision design.