单侧唇裂口轮匝肌分束重建后并发症及原因探讨

Analysis the postoperative complications of unilateral cleft lip repaired with differentiated reconstruction of the orbicularis oris muscle

目的探讨单侧唇裂行口轮匝肌分束重建后并发症的发生原因,并寻求其解决途径。方法对采用口轮匝肌分束重建术的30例单侧完全性唇裂患者的疗效进行评估,并从解剖学角度分析并发症的发生原因。结果所有病例在行患侧口轮匝肌鼻束内推复位时均有不同程度的张力,裂隙宽大者鼻束复位困难。术后随访30例患者3个月,并发患侧鼻孔缩小畸形者5例,Millard法的C瓣尖端皮肤糜烂、愈合不良者6例。结论该术式存在患侧口轮匝肌鼻束复位后张力大,易导致患侧鼻孔缩小畸形;充分剥离健侧口轮匝肌,有可能导致Millard术式的C瓣尖端皮肤血供不良而形成坏死、糜烂。因此,该术式须进行改良。

Objective To analyze the reasons for postoperative complications of unilateral cleft lip repaired with differentiated reconstruction of the orbicularis otis muscle and exploration of approach to solution of complications. Methods Reasons for postoperative complications from an anatomical point of view in 30 cases of tmilateral complete cleft lip repaired with differential re- arrangement of orbicularis oris muscle components were investigated and analyzed. Results We found there were was great tension generated by repair of the nasal bunds with the orbicularis oris muscle. Thirty cases were followed for 3 months postoperatively, and 5 cases showed contracted nostrils, and 6 cases had skin erosion in the tip of the ＂C＂ skin flap incised by the Millard technique. Conclusion This method may show defects wherein the nasal bundle on the lateral side is pushed to ainterior nasal spine because of great tension which may lead to contracted nostrils. Moreover, extensively dissecting the medial orbicularis oris may cause skin erosion in the tip of the ＂C＂ skin flap incised by the Millard technique.