双侧完全性唇裂同期修复唇鼻畸形

Simultaneous repair of bilateral complete cleft lip nose： ten-year follow-up results

目的观察双侧唇裂同期修复唇鼻畸形的远期效果。方法以16例先天性完全性双侧唇裂患儿为实验组，选取30例正常儿童为对照组，均在修复唇裂的同时在鼻唇角部位做V-Y成形术，解剖和保护鼻小柱前唇动脉，以确保前唇血运，显露及矫正错位的两侧鼻翼软骨并相互缝合，修复鼻畸形。术后10年随访时拍摄面部正、侧及后仰位像片，并测量鼻唇部解剖标志点的直线距离和角度值．与对照组正常儿童进行比较，以评估手术效果。结果实验组患儿鼻形态可以令人接受，远期效果稳定。但与正常同龄对照组测量数据比较，鼻小柱及鼻长相等，其中鼻宽度、鼻小柱宽度、鼻尖突度、鼻唇角均大于正常值（P〈0．05）。结论在仔细解剖、妥善保护鼻小柱前唇动脉及前唇血运的前提下，同期修复双侧唇裂和鼻畸形，可以获得令人接受和稳定的远期效果，是较为可取的修复方法之一。

Objective To explore the method to correct nasal deformity of the bilateral complete cleft lip and to eveluate the benefits of this teachnique. Methods Sixteen patients with the bilateral complete cleft lip were consecutively chosen to correct the nasal deformity of the bilateral complete cleft lip. We performed an open approach to facilitate Mar cartilage manipulation while repairing the bi- lateral complete cleft lip, and elevated the prolabial flap for reconstructing the continuity of orbicularis oris muscle artery by anatomizing and protecting the prolabial-columel｜ar artery. Nasal columella length and wideth, nasal wideth, ratio of nasal length to face length, ratio of nasal wideth to the dis- tence of nasolabial angle were analyzed after a minimum of 10 years after surgery. These were com- pared with those in a normal, age-matched control group. Results Appreance of nose and lip of 16 pa tients after surgery were satisfying and long-term results were good by following-up for 10 years. Col- umellar length and ratio of nasal length to face length were not significantly different from that of the control group. Nasal wideth, columella wideth, tip projetion and nasolabial angle were all significantly greater in the cleft group than the normal （P〈0.05）. Conclusions Prolabial flap manipulation is a safe approach by using anatomizing the columellar-labial artery. This teachnique is effective and yields good long-term results.