双侧唇裂术后鼻唇畸形的修复

A NEW METHOD TO REPAIR THE BILATERAL CLEFT LIP NASAL DEFORMITY

目的 报道双侧唇裂术后鼻唇畸形修复的一种新方法。方法 在双侧鼻孔的内侧沿鼻小柱皮肤粘膜交界缘向下达鼻小柱基部并经鼻底向外达外侧脚外侧并绕鼻翼外侧脚弧形向上;在上唇正中上部画出叉形瓣切口线;再在双侧鼻孔底部上唇瘤痕两侧画垂线至唇红缘。然后切开鼻底及鼻翼外侧脚皮肤,在鼻翼内侧脚上端缝合。将叉形瓣向上推形成鼻小柱下端。切除上唇瘢痕组织,必要时可设 Abbe瓣经旋转180°后按粘膜、肌层及皮肤层缝合。10～14天行Abbe瓣断蒂。结果 用该术式对34位患者进行了手术,术后鼻唇外形、鼻小柱长度及鼻孔大小趋于正常。上唇过紧得到了松驰。结论 该术式对双侧唇裂术后鼻唇畸形矫正有用。

ve This article describes a new method to repair the bilateral cleft lip nasal deformity. Methods This technique is that the crosshached areas above the cleft nostril toward the tip of the nose are excised . This is skin only . The incision down the columella across the vestibule of nose and around the ala is a deep incision running all the way through the soft tissue down to the mucous membrance on the each side. At the base of the columella, a forked flap incision is made. The skin over the alar cartilage on each side is completely separated from that cartilage within the incision above the cleft nostril. Once the nostril on the lower lateral cartilage and the ala have been adequately freed , the two nostrils are rotated from lateral to medial and superior to fill in the defects that be created when the crescent of skin be removed, the cartilage can be put into its new position. The lower crura are sutured to one another, the alar cartilages are rotated medially and sutured to one another. The forked flap is advanced upperiorly to form lower part of the columella and bring the nasal tip forward . When the upper lip is deficient, an Abbe flap of the lower lip may be used for upper lip reconstruction . Results The nasal shape, involving the columellar length and the concavity between the nasal tip and lateral ala can be improved . Conclusion This technique is especially useful to repair the bilateral cleft lip nasal deformity.