State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
PLoS One. 2018 Apr 13;13(4):e0195583. doi: 10.1371/journal.pone.0195583. eCollection 2018.
The relapse of nasal deformity is a challenge for modern correction of cleft lip. A comprehensive understanding in the biomechanical perspective of both the formation and correction of the cleft lip nasal deformity would lead to improved stability of the corrective outcome. In this study, a finite element model of secondary cleft lip nasal deformity was constructed, on which two critical corrective maneuvers were mimicked in the form of force-loading. The intercrural suture was simulated by a force loaded at the intermediate crus of the alar cartilage directing anteriorly and medially, and the suture suspending the alar cartilage to the upper lateral cartilage was simulated by a force loaded at the lateral crus directing superiorly and medially. The equivalent von-mises stress and the total deformation consequent to different patterns of loading were captured. Our biomechanical analyses suggested that the intercrural suture at the nasal tip might be more effective in generating widespread morphological change than the suspension suture, but left much higher level of stress within the skin envelope if placed too high. Synergistic effect was observed between the two sutures in both the resultant deformation and stress. In addition, our simulations were partially supported by clinical photogrammetry data.
鼻畸形复发是现代唇裂矫正的一个挑战。全面了解唇裂鼻畸形的形成和矫正的生物力学观点，将有助于提高矫正效果的稳定性。本研究构建了继发唇裂鼻畸形的有限元模型，通过力加载的形式模拟了两种关键的矫正操作。通过在前侧和内侧加载鼻翼软骨中间脚的力来模拟鼻翼内脚缝线，通过在上侧和内侧加载鼻翼软骨悬吊至外侧上侧软骨的力来模拟悬吊缝线。记录了不同加载模式下的等效 von-Mises 应力和总变形。我们的生物力学分析表明，位于鼻尖的鼻翼内脚缝线可能比悬吊缝线更有效地产生广泛的形态变化，但如果缝线放置过高，会在皮肤包膜内产生更高水平的应力。两种缝线在总变形和应力方面都表现出协同作用。此外，我们的模拟结果部分得到了临床摄影测量数据的支持。
