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, 610041.
College of Physicians and Surgeons, Columbia University, New York, US, 10032.
J Plast Reconstr Aesthet Surg. 2020 Sep;73(9):1717-1722. doi: 10.1016/j.bjps.2020.03.010. Epub 2020 Mar 16.
To demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction.
The surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method.
Finite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up.
Force balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.
演示一种在初次单侧不完全唇裂修复中实现重建的口轮匝肌最佳力平衡的操作方法。
手术操作如下：首先分离和调整非裂侧口轮匝肌的长度使其与裂侧肌肉的长度相等。将中线附近的非裂侧剩余肌肉用于填充唇红结节，最后将两侧口轮匝肌在中线缝合。采用有限元分析对我们新的手术方法的生物力学进行建模。
有限元分析表明，初次唇裂修复后，当两侧口轮匝肌长度相同时，在不同的唇形下，该肌肉系统的受力最小。17 例唇裂患者接受了这种新方法的重建。在术前与术后、术前与随访、术后与随访的比较中，非裂侧/裂侧鼻翼基底宽度、鼻背角度、两侧鼻中隔长度关系和鼻中隔角度均有显著差异。
在单侧不完全唇裂修复中，口轮匝肌的力平衡很重要。这种实现口轮匝肌和唇部肌肉系统力平衡的手术操作简单易行，可以帮助避免复发。
