双侧唇裂术后上唇短小合并鼻畸形治疗.doc

双侧唇裂术后上唇短小合并鼻畸形治疗[摘要]目的：探讨双侧唇裂术后上唇短小合并鼻畸形的矫正方法。方法：将前唇整块上移延长鼻小柱，双侧外侧唇颊瓣向中线推进，Ⅰ期修复唇部组织缺损，恢复口轮匝肌的连续性，同时矫正鼻尖低平、鼻孔宽大、重建人中嵴。结果：临床治疗7例，术后切口均Ⅰ期愈合，随访10天～24个月，唇、鼻畸形明显改善。结论：利用前唇上移和双侧外侧唇颊瓣推进是解决上唇短小合并鼻畸形的一种有效方法。 [关键词]双侧唇裂；唇；鼻；畸形 [中图分类号]R782 [文献标识码]A [文章编号]1008-6455（2011）09-1396-02 Corection of upper lip shortness and nasal deformities after the repair of bilateral cleft lip CUI Zi-wei,HE Cheng-jun,YANG Ying,WANG Wei-dong,LI Hong-yan （Department of Plastic Cosmetic Surgery, Daqing Oilfield General Hospital, Daqing 163001, Heillongjiang,China） Abstract:Objective To explore the method for correcting the deformities of lip and nose. MethodsThe whole prolabium was advanced upward to lengthen the columella,then the bilateral lip and check tissues were push toward midline.In the meantime,alar base was reposited and the nostrils was reshaped,nasal tip was elevated by using silica gel prothesis,the continuity of the bilateral orbicular muscle of mouth were reconstructed and the philtrum ridge was repaired in one stage.Results 7 patients were followed up for 10 days to 12 months,all of them showed one-stage healing and obvious improvement in appearance of their lips and noses.Conclusion The application of advancing the prolabium upward and bilateral lip and cheek tissues toward midline is an effective method for the deformities of lip and nose. Key words:bilateral cleft lip;lip;nose;deformity 双侧唇裂经过Ⅰ期修复仍存在很多继发畸形[1-4]。对于上唇短小合并鼻畸形的治疗，由于唇、鼻组织量不足导致Ⅱ期修复很困难，自2006～2011年，笔者利用前唇上移、双侧颊部推进的方法，修复唇、鼻组织量的不足，取得了较好的效果。 1资料和方法 1.1临床资料：本组患者7例（男4例，女3例），年龄10～24岁，均为双侧唇裂患者。Ⅱ期手术距初次手术时间7～23年。 1.2手术方法：手术切口如图1a中的美兰标记线，采用双侧眶下神经阻滞麻醉，麻醉显效后，沿前唇、鼻孔下缘及鼻孔内侧缘标记线切开，将Ⅰ期修复术后在上唇留下的两条纵行瘢痕去表皮，分离出深处的瘢痕组织条，保留蒂部位于唇弓处，在两瘢痕条的外侧于皮下及轮匝肌下向两侧的颊部充分剥离，形成侧唇皮瓣和口轮匝肌瓣，将整块短小的前唇-鼻小柱皮瓣一同掀起（如图1b）,在鼻背区浸润麻醉，于鼻背筋膜下剥离出硅胶假体置入腔隙，将雕刻好的假体置入鼻背筋膜下腔隙，拉拢两侧轮匝肌瓣，在中线处重叠缝合，于鼻孔下缘横切口内将两侧鼻翼外侧脚松解后拉拢缝合，缩小宽大的鼻孔基底部（如图1c），将前唇瓣上方与鼻小柱相连的部分修窄作为鼻小柱延长的部分，缝合鼻孔缘切口，将两侧颊部皮瓣于皮下拉拢缝合，将前唇皮瓣的下方两侧切开，形成两条蒂在上方的皮瓣，皮瓣的大小与鼻孔下方的空隙相当，将两皮瓣插入鼻孔下方空隙中缝合固定（如图1d～1