Xu Yulang, Yao Meilin, Li Chenghao, Shi Bing, Li Jingtao, Zheng Qian, Zeng Ni
From the State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University.
Plast Reconstr Surg. 2025 Sep 1;156(3):466-475. doi: 10.1097/PRS.0000000000011975. Epub 2025 Jan 22.
The authors conducted an objective assessment of the long-term postoperative outcomes of a modified rotation advancement combined with force balance orbicularis oris muscle reconstruction in patients with unilateral complete cleft lip and palate.
Consecutive patients undergoing cleft lip primary repair were included (n = 90). Three-dimensional images preoperatively (n = 90), postoperatively (n = 90), and at 5-year follow-up (n = 57) were assessed and compared with age-matched controls.
In preoperative measurement, the subnasale and pronasale both exhibited a significant deviation. The cleft subalare was displaced both medially and posteriorly in comparison with the controls. Conversely, the noncleft subalare demonstrated a lateral drift. These observations collectively indicated an overall lateral drift of the nasal base toward the noncleft side. Surgical intervention successfully resulted in landmark positions that closely mirrored those of the controls. The symmetry of the nasal base was maintained at late follow-up within the cleft lip group. However, there was a significant downward and retrusive displacement of the cleft alar base, along with a notable lateral displacement of the subnasale and the noncleft alar base in both the cleft lip and alveolus/palate groups.
The modified rotation advancement technique combined with force balance reconstruction of orbicularis oris results in promising symmetry of the nasal base in patients with unilateral complete cleft lip. The alar base retrusion in patients with cleft lip and alveolus/palate is probably attributable to bony defect, which might be addressed by secondary alveolar bone grafting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
作者对改良旋转推进联合口轮匝肌力量平衡重建术治疗单侧完全性唇腭裂患者的术后长期疗效进行了客观评估。
纳入连续接受唇裂一期修复的患者（n = 90）。对术前（n = 90）、术后（n = 90）及5年随访时（n = 57）的三维图像进行评估，并与年龄匹配的对照组进行比较。
术前测量时，鼻小柱和鼻前棘均表现出明显偏移。与对照组相比，患侧鼻翼基部向内侧和后方移位。相反，健侧鼻翼基部出现外侧漂移。这些观察结果共同表明鼻基底整体向非患侧外侧漂移。手术干预成功使标志性位置与对照组相近。唇裂组在随访后期鼻基底的对称性得以维持。然而，唇裂合并牙槽突/腭裂组中，患侧鼻翼基部有明显的向下和后缩移位，同时鼻小柱和健侧鼻翼基部有明显的外侧移位。
改良旋转推进技术联合口轮匝肌力量平衡重建术可使单侧完全性唇裂患者的鼻基底对称性良好。唇裂合并牙槽突/腭裂患者的鼻翼基部后缩可能归因于骨缺损，可通过二期牙槽骨植骨解决。
临床问题/证据级别：治疗性，IV级。
