Ganske Ingrid M, Langa Olivia C, Mulliken John B
From the Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School.
Plast Reconstr Surg. 2021 Jan 1;147(1):141-147. doi: 10.1097/PRS.0000000000007460.
Cleft surgeons try to construct a philtral ridge during primary repair of a cleft lip, but rarely document the results. The authors used three-dimensional photogrammetry to measure projection of philtral ridges after closure of the common forms of unilateral labial cleft.
This is a retrospective study of patients with unilateral complete, incomplete (moderate and severe), and microform cleft lip repaired by one surgeon from 2000 to 2013. Cleft type determined the technique for building a philtral ridge. The relative elevation of the ridge on the cleft versus noncleft side was measured on three-dimensional childhood photographs at two locations along the philtrum: just above the Cupid's bow and at the midlabial level.
Thirty-four patients were evaluated at a mean age of 9.25 years. All cleft types exhibited greater projection at the philtral midlabial level compared with the Cupid's bow level. The authors found a trend toward a more prominent cleft side philtral ridge in microforms. In incomplete cleft lips, there was slightly greater philtral ridge projection in severe forms repaired after a preliminary nasolabial adhesion compared with those repaired in a single stage. There was similar projection of the cleft side ridge in two-stage complete and single-stage repaired incomplete lips.
It is possible to construct a philtral ridge that is as prominent as the noncleft side in all types of unilateral cleft lip. Increased muscle thickness may explain the slightly increased philtral ridge projection in patients with an incomplete cleft repaired in two stages compared to one-stage closure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
唇裂外科医生在唇裂一期修复术中试图构建人中嵴，但很少记录结果。作者使用三维摄影测量法来测量常见类型的单侧唇裂修复后人中嵴的突出度。
这是一项对2000年至2013年由同一位外科医生修复的单侧完全性、不完全性（中度和重度）及微小型唇裂患者的回顾性研究。唇裂类型决定构建人中嵴的技术。在儿童期三维照片上，沿着人中的两个位置测量裂隙侧与人非裂隙侧人中嵴的相对高度：恰好在唇弓上方和唇中部水平。
对34例患者进行了评估，平均年龄为9.25岁。与唇弓水平相比，所有唇裂类型在人中唇中部水平的突出度更大。作者发现微小型唇裂中裂隙侧人中嵴有更突出的趋势。在不完全性唇裂中，与一期修复的相比，在初步鼻唇黏附术后修复的重度不完全性唇裂人中嵴突出度略大。在二期修复的完全性唇裂和一期修复的不完全性唇裂中，裂隙侧嵴的突出度相似。
在所有类型的单侧唇裂中都有可能构建出与人非裂隙侧一样突出的人中嵴。肌肉厚度增加可能解释了与一期闭合相比，二期修复的不完全性唇裂患者人中嵴突出度略有增加的原因。
临床问题/证据水平：治疗性，IV级。
