Breitsprecher L, Fanghänel J, Waite P, Steding G, Gasser R
Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie/Plastische Operationen, Universitätsklinikum Greifswald, Sauerbruchstrasse, 17487 Greifswald.
Mund Kiefer Gesichtschir. 2002 Mar;6(2):102-10. doi: 10.1007/s10006-001-0362-3.
The great variety of primary cheiloplastic procedures in CLP patients shows that there is disagreement regarding the embryological development of this part of the face, the point selection, skin incision philosophy, and the macroscopic and microscopic functional anatomy of the human muscles of facial expression. We suppose from findings in Asian and African populations that the real embryological development of the upper lip differs from current textbook descriptions. Our own anatomical and embryological investigations serve as a basis for a critical discussion of different techniques of muscle reconstruction, point selection, and skin incision and for a description of an embryologically, functionally, and anatomically oriented operation technique for different entities of CLP.
The findings of this study result from investigations of the embryonal and early fetal development from the 26th to the 112th i.u. day in REM pictures of the Anatomical Institute of the University of Göttingen (n = 8) and serial histological investigations of the Carnegie and Hooker-Humphrey Collections at the Armed Forces Institute of Pathology, Washington, D.C. (n = 40). Furthermore, we carried out microsurgical dissections of the muscles of facial expression, the osseous and cartilaginous parts of the nose, and the midfacial sutures in two adult heads without congenital disorders and one newborn head with a primary unilateral complete cleft of the lip and alveolus.
The formation of the lower third of the upper lip is the result of contact of the maxillary bulges in the midline below the prolabium. According to this finding, the point selections and skin incisions have to be modified in the midline region in different types of uni- and bilateral CLP. Our technique of primary dissection, reorientation, and suturing of the muscles of facial expression is presented. The muscle reconstruction has to be performed independently from the skin preparation.
唇腭裂（CLP）患者的一期唇成形手术种类繁多，这表明在面部这一部分的胚胎发育、选点、皮肤切口理念以及人类面部表情肌的宏观和微观功能解剖方面存在分歧。我们从亚洲和非洲人群的研究结果推测，上唇的实际胚胎发育与当前教科书描述不同。我们自己的解剖学和胚胎学研究为批判性讨论不同的肌肉重建技术、选点和皮肤切口提供了基础，并为不同类型的唇腭裂描述了一种基于胚胎学、功能学和解剖学的手术技术。
本研究结果来自于对哥廷根大学解剖研究所（n = 8）第26至112个国际单位日的胚胎和早期胎儿发育的REM图像研究，以及华盛顿特区武装部队病理研究所卡内基和胡克 - 汉弗莱藏品的系列组织学研究（n = 40）。此外，我们对两个无先天性疾病的成人头部以及一个患有原发性单侧唇和牙槽完全裂开的新生儿头部进行了面部表情肌、鼻骨和软骨部分以及面中部缝线的显微外科解剖。
上唇下三分之一的形成是上颌隆起在唇前下方中线处接触的结果。根据这一发现，在不同类型的单侧和双侧唇腭裂的中线区域，选点和皮肤切口必须进行修改。我们介绍了面部表情肌的一期解剖、重新定位和缝合技术。肌肉重建必须独立于皮肤准备进行。
