双切口鼻唇肌肉三维定向立体重建术矫正单侧唇裂修复术后继发畸形的疗效

Outcome of double-cut correction on secondary deformity after unilateral cleft lip repair with nasolabial muscle reconstruction

目的探讨双切口鼻唇肌肉三维定向立体重矫正单侧唇裂修复术后继发鼻唇畸形手术方法及效果。方法将单侧唇裂修复术后继发畸形14例患者采用鼻唇肌肉三维定向立体重建术，另4例患者在鼻唇肌肉三维定向立体重建基础上在健侧红唇增加辅助切口，通过鼻小柱底部肌肉下隧道将两侧的鼻翼外侧角附近鼻肌翼部肌束进行缝合，两侧口轮匝肌瓣重叠缝合，重建形成人中窝及人中嵴。结果18例患者术后切口均Ⅰ期愈合，14例患者鼻部畸形较传统方法改善明显，患侧鼻底丰满，鼻槛形态接近健侧，并且重建了人中窝及人中嵴，外观明显，形态对称。两侧鼻孔大小、鼻底、鼻槛及外形良好。另4例在健侧红唇增加辅助切口的患者修复效果明显，修复后两侧鼻孔大小、鼻底、鼻槛及外形几乎完全对称，达到术前设计效果。结论双切口鼻唇肌肉三维定向立体重建术适用于矫正单侧唇裂修复术后继发畸形，可以更好的恢复两侧鼻孔外形的对称。

Objective To investigate the surgical methods and effect of double-cut nasolabial muscle directional three-dimensional reconstruction on the secondary deformity of unilateral cleft lip repair. Methods We first increased a contralateral vermilion secondary incision based on the nasolabiat muscle directional three-dimensional reconstruction, without damaging the contralateral white lip skin, via suturing both sides of nose wings bundle of nose outside corner under the columella muscle, and overlapping suturing both sides of the orbicularis muscle flap, and then rebuilt and took shape of the nest and the crest. Results All incisions healed well in 18 patients, all nasal deformities were cor- rected better than the traditional methods, with the nasal base plump, the nasal sill formed close to the contralateral side, and rebuild the philtrumdimple and philtrum crest, with clear appearance and symmetrical form. A good appearance was obtained on the both sides of nostril, nasal base and the nasal sill, and the effect of preoperative design achieved. Conclusions Both sides of the nostrils size, nasal sill and shape are almost perfectly symmetrical, and the double-cut nasolabial muscle directional three-dimensional reconstruction is suitable for repairing the secondary deformity after unilateral cleft lip repair.