婴儿期单侧唇裂鼻畸形矫治

Early correction of nasal deformities with unilateral cleft lip in infant

目的 探讨在婴儿期功能性修复单侧唇裂的同期 ,矫正唇裂鼻畸形。方法 采用Millard术式 ,同期经唇入路矫正鼻畸形 ,即分别经由鼻小柱与鼻翼基部锐分离鼻大翼软骨与鼻翼皮肤 ,在使大翼软骨恢复正常解剖之后 ,其内侧面软组织也随之整体移动 ,故无需解剖大翼软鼻内侧面、鼻中隔软骨及鼻骨。口轮匝肌的修复则恢复了鼻周肌肉的动力平衡 ,经Millard术式 ,矫正鼻小柱偏斜 ,恢复鼻底的完整 ,初步完成了鼻畸形的矫正。结果 80例单侧唇裂鼻畸形患儿经此法矫正后 ,效果满意者 52例 ,效果一般者 1 7例 ,差者 1 1例。结论 在功能性修复唇裂的基础上 ,由唇入路行较简单而创伤小的鼻畸形矫正术 。

Objective To investigate the surgical correction of alar deformity and repairing function of unilateral cleft lip in infant. Methods Millards procedure was used to incise skin, muscle and mucosa, correct the nasal deformity through lip. At the normal side, ophthalmic scissors was applied to incise lips muscle and skin, and reach the deep level of the base of nasal pillor, cut the abnormal attachment between the orbicular muscle of mouth and anterior nasal spina, and sharp dissect cartilage and skin in nasal wing through deep level of nasal pillor. At the cleft side, the abnormal muscle branch was cut that attached at the down side of the base of nose and pyriform aperture, the tissue between nasal base and lip, maxilla relaxed, and the cartilage and skin in the nasal wing at the same side dissected. The deform cartilage was repairied as the same of normal side. After the rehabilitation of cartilage of nasal wing, the soft tissue at deep level was moved to normal location, but the deep level structure of nasal wing cartilage, nasal septum cartilage and nasal bone did not dissected. After the dissection of orbicular muscle of mouth, the muscle in nose and lip must be relaxed in illous side. The orbicular muscle of mouth was sewed under the condition of tensionless. The repairing of orbicular muscle of mouth will improve the balance of muscular strength around the nose. Thus, the deviation of nasal pillor was corrected and the base of nose repaired. Results Eighty cases of infant with unilateral cleft lip at the age of 3 months ～12 months, in which 11 cases were Ⅰ°,16 Ⅱ, and 3 Ⅲ°. Eighty cases were low grade alar deformity, and 13 middle grade deformity. After operation, 52 cases were better, 17 cases were good, and 11 cases were worse. The postoperational result was good. Conclusion While performing the cleft lip operation or Millard operation, the authors can correct the nasal deformity through lip. So, it is recommended that cleft lip and the alar deformity can be repaired at the same time.