Tatum Sherard A
Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Upstate Medical University, Syracuse, NY 13210, USA.
Facial Plast Surg. 2007 May;23(2):91-9. doi: 10.1055/s-2007-979277.
Reconstruction of the unilateral cleft lip deformity remains a challenge. The Millard repair is the most commonly employed technique of lip closure. Wide clefts with malaligned alveolar arches and very short cleft-side philtral ridges are particularly difficult to reconstruct well. These cases frequently require some degree of cleft-side alotomy with attendant scarring and potential growth disturbance. Additionally, the lip scar tends to cross the philtrum at an aesthetically unsatisfactory low level. Nasoalveolar molding is one method to address these problems, but is not always available or practical. Alternatively, a two-stage lip repair serves as a reasonable means of managing these problems as well. The first stage, performed at approximately 4 to 6 weeks of age, is a full-thickness straight-line repair with tip rhinoplasty. The second stage is a modified Millard repair done at approximately 6 months of age. An alotomy is never needed. The lip scar does not cross the philtrum until the nasolabial crease. The alveolar segments are passively brought closer together by the early lip repair facilitating anterior palate closure. This technique has been used for more than 10 years with satisfying aesthetic and functional results.
单侧唇裂畸形的修复仍然是一项挑战。米勒德修复术是最常用的唇部闭合技术。伴有牙槽弓排列不齐和患侧人中嵴非常短的宽裂隙尤其难以良好修复。这些病例通常需要某种程度的患侧唇缘切开术，随之而来的是瘢痕形成和潜在的生长紊乱。此外，唇部瘢痕往往会在美学上令人不满意的较低位置穿过人中。鼻牙槽塑形是解决这些问题的一种方法，但并不总是可行或实用。另外，两阶段唇修复也是处理这些问题的合理方法。第一阶段在大约4至6周龄时进行，是全层直线修复并伴有鼻尖整形术。第二阶段是在大约6个月龄时进行的改良米勒德修复术。从不需进行唇缘切开术。唇部瘢痕直到鼻唇沟处才会穿过人中。早期的唇修复使牙槽段被动地靠得更近，有利于前腭裂的闭合。这项技术已经使用了10多年，取得了令人满意的美学和功能效果。
