唇鼻肌肉第一副张力线组重建技术修复唇裂术后继发鼻槛畸形

First auxiliary muscle tension line group reconstruction for nostril sill repair in cleft lip patients

目的探讨通过重建唇鼻肌肉张力线组矫正单侧唇裂术后继发鼻槛畸形的方法及术后效果评估。方法2012年1月至2016年12月,对437例单侧唇裂术后继发鼻槛畸形的患者,通过重建第一副张力线组达到新的生物力学平衡进行修复。依据全球美学改善量表制定的标准,对术后效果进行主观评价。采用随机数字表法随机选择24例随访期内的患者进行三维测量分析,采用配对t检验对术后鼻部对称性进行客观评价。结果术后11例患者由于感染或鼻底黏膜血运不良鼻底遗留明显瘢痕,其余患者均一期愈合。术后6个月至3年,378例患者完成调查表,结果显示,84%(317/378)的患者认为鼻槛形态得到明显或适度地改善;通过三维测量分析发现,鼻小柱脚、鼻翼基底部及鼻翼最外侧点的位置在患侧及健侧差异均无统计学意义(P>0.05),提示术后患者的鼻部对称性较好。结论重建第一副张力线组的方法,不是简单地增加鼻槛的体积,而是恢复了唇鼻部的生物力学平衡,是修复鼻槛畸形的有效手段,而且鼻小柱偏斜及鼻翼外展畸形同时得到很好地矫正。

Objective This study is to repair nostril sill deformity in the cleft lip patients by reconstructing the first auxiliary muscle tension line group and to assess the therapeutic outcome.Methods 437 cleft lip patients with nostril sill deformity underwent the surgery from January 1, 2012 to November 1, 2016.They were treated using the technique of first auxiliary muscle tension line group reconstruction to repair the deformity. Aesthetic correction evaluations were rated by the GAIS. Random digit was used to randomly select 24 patients during the follow-up for three-dimensional measurement and analysis. The preoperative and postoperative symmetry of the nostril sills were evaluated by paired t test.Results Mucosal ischemia or wound infection occurred in 11 cases, left obvious scar on the nostril floor. Surgical incisions of the other patients were primary healing. After 6 months to 3 years follow up, GAIS questionnaires of 378 patients demonstrated that 84% patients reported great or moderate improvement of nostril sills. Three-dimensional measurements of 24 patients suggested that there were no significant differences of the nostril sill and the nasal ala between the cleft side and the normal side.Conclusions First auxiliary tension line group reconstruction, which is to restore biomechanical balance rather than merely increase muscle volume, is an effective method of nostril sill repair in the cleft lip patients. Post-operatively, the patients achieved a stable and natural nostril sill, a middle columella, as well as a narrowed nasal ala.