Matic Damir B, Power Stephanie M
Division of Plastic and Reconstructive Surgery, Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
J Craniofac Surg. 2011 Mar;22(2):514-9. doi: 10.1097/SCS.0b013e3182085576.
The lateral bulge deformity may result after primary cleft lip repair. In a pilot study, greater orbicularis oris thickness and levator width underlying the lateral bulge were identified using ultrasound. The purpose of this study was to evaluate postoperative results of anatomic muscle repair for lateral bulge correction.
Patients with a lateral bulge after primary unilateral cleft lip repair were prospectively recruited. Oronasal musculature and connective tissue dimensions were measured using ultrasound, preoperatively and postoperatively. Guided by preoperative ultrasound findings in each patient, lateral bulge correction consisted of total lip takedown and anatomic orbicularis oris reapproximation. Within each group, measurements between sides at corresponding landmarks were compared using t-tests. Ratios between sides at corresponding landmarks preoperatively and postoperatively were compared using parametric and nonparametric tests. Repeat measurements were performed to calculate intrarater reliability. Standardized video assessments of dynamic lip function were recorded preoperatively and postoperatively.
Average patient age was 17.4 years. Patients were evaluated preoperatively and postoperatively (n=14) at 7.8 months' mean follow-up. Cleft-side orbicularis thickness and levator width were greater preoperatively versus postoperatively (P=0.003 and P=0.018, respectively). Postoperatively, no differences were seen between sides for both orbicularis thickness (P=0.763) and levator width (P=0.626). All patients demonstrated improved lip contour and symmetry, both static and dynamically, on video assessments.
Lip contour, function, and aesthetics improved clinically, and lip muscle anatomy normalized postoperatively as assessed using ultrasound. Complete orbicularis oris takedown and anatomic reapproximation effectively addressed the lateral bulge deformity.
一期唇裂修复术后可能出现外侧膨隆畸形。在一项初步研究中，通过超声检查发现外侧膨隆下方的口轮匝肌厚度更大且提肌宽度更宽。本研究的目的是评估解剖性肌肉修复矫正外侧膨隆的术后效果。
前瞻性招募一期单侧唇裂修复术后出现外侧膨隆的患者。术前和术后使用超声测量口鼻部肌肉组织和结缔组织的尺寸。根据每位患者术前超声检查结果，外侧膨隆矫正包括全唇翻瓣和口轮匝肌解剖复位。在每组中，使用t检验比较相应标志点两侧的测量值。使用参数检验和非参数检验比较术前和术后相应标志点两侧的比值。进行重复测量以计算评估者内部信度。术前和术后记录标准化的动态唇功能视频评估。
患者平均年龄为17.4岁。在平均7.8个月的随访期内对患者进行术前和术后评估（n = 14）。术前患侧口轮匝肌厚度和提肌宽度大于术后（分别为P = 0.003和P = 0.018）。术后，口轮匝肌厚度（P = 0.763）和提肌宽度（P = 0.626）两侧均无差异。所有患者在视频评估中均显示静态和动态唇轮廓及对称性均有改善。
临床观察发现唇轮廓、功能和美观度均有改善，并且术后使用超声评估显示唇肌解剖结构恢复正常。完全口轮匝肌翻瓣和解剖复位有效地解决了外侧膨隆畸形。
