个体化单侧唇裂修复术式的改进

Improvement on the Individual Operative Design ;of Unilateral Cleft Lip Repair

目的 :进一步探讨对每一例单侧唇裂患者畸形特点更具针对性的个体化单侧唇裂修复术式的设计 ,使手术设计简便 ,以利临床应用。方法 :采用几何学解析的方法 ,以正常人两侧鼻翼基部和鼻小柱基部中点到两侧唇峰的距离相等为模板 ,对个体化单侧唇裂修复术式的定点与切口进行设计。结果 :首次提出健侧唇上鼻小柱下方切口止点的设计是以健患侧唇峰与人中切迹连线所成夹角的角平分线和健侧人中嵴的交点定点 ;患侧鼻翼基部点的设计则是以过健侧鼻翼基部水平线与患侧鼻翼外侧缘的交点定点的设计原则。根据单侧唇裂患者健患侧鼻翼唇峰距的不同 ,设计出适用于患侧唇高等于和小于健侧唇高的两种手术术式。结论 :改进后的个体化单侧唇裂修复术式 ,定点与切口设计更加科学准确 。

Objective: To study the difference of operative designs in unilateral cleft lip repair according to characteristic deformity of each patient with unilateral cleft lip. Methods: The distance from both alar bases and midpoint of columella base to both peaks of Cupid′s bow were consulted is equal as standard design model. The mark point and incision of individual unilateral cleft lip repair were designed using geometrical analysis. Results: The new operative design technique included that the end point of rotational incision should be inside of the cross point from the line dividing both Cupid′s bow peaks and philtrum on the non cleft side, and the other design was that the end point of alar base on the cleft side located at the cross point from the horizontal line that passed the midpoint of alar base on the non cleft side to meet the alar base on the cleft side. Depending on the above thesis, the new operative methods were created for unilateral cleft lip repair. One of the new individual operative designs was similar with Millard′s method in the shape of operative design, but there was a big difference on the principle of marking the columella base and alar base on the cleft side between individual operative designs and Millard′s design. This new operative design only suit for unilateral cleft lip with symmetric distances from alar base to Cupid′s bow peaks in both sides. Another individual operative design added a new incision on the cleft side comparing with the former individual operative design, which could be used in unilateral cleft lip when the distance from alar base to Cupid′s bow peak on the cleft side was shorter than that on the non cleft side. Conclusion: The new individual operative designs of unilateral cleft lip repair have been created, and the important advantages of these new individual operative designs are that each marking point can been decided clearly according to special mathematical principles. Each operative design only suit for one type of unilateral cleft deformity, so the types of deformity in unilateral cleft lip can been also classified depending on the different distances from alar base to Cupid′s bow peak between both sides. This classification of unilateral cleft lip only depends on operative designs, and these new individual operative designs of unilateral cleft lip repair are easy to be understanded and applied, as well as easy to obtain stable result after operation. ;