Longaker M T, Lipshutz G S, Kawamoto H K
Division of Plastic and Reconstructive Surgery, UCLA School of Medicine, USA.
Plast Reconstr Surg. 1997 May;99(6):1501-7.
Atypical craniofacial clefts present a surgical challenge. Little is published about their treatment because of their rarity. Such is the nature of Tessier no. 4 clefts and others with shortened oculoalar and oculo-oral distances requiring multiple operative interventions. The soft-tissue abnormalities include a cleft of the lip with possible extension into the check, orbital dystopia, and globe abnormalities and a decreased oculo-oral distance. Typically, multiple local cheek and nasal flaps are used to close the soft-tissue defects, elevate the medial canthus, and protect the globe. However, this approach creates traction on the lower eyelid, suboptimal location of the scar, and poor color match between the flaps. We present two cases of Tessier no. 4 clefts and one case of a multiply clefted (Tessier nos. 1/13, 2/12, 3/11) child with the typical contracted oculoalar and oculo-oral distances. Reconstruction with a superiorly based nasolabial flap transposed 90 degrees under the eye was performed in all three as a primary procedure. This technique respects aesthetic units and places the resulting scars in less conspicuous areas on the face.
非典型颅面裂带来了手术挑战。由于其罕见性，关于其治疗的文献报道很少。这就是Tessier 4号裂及其他眼颧和眼口距离缩短、需要多次手术干预的裂的情况。软组织异常包括唇裂可能延伸至面颊、眼眶异位、眼球异常以及眼口距离减小。通常，使用多个局部面颊和鼻瓣来闭合软组织缺损、抬高内眦并保护眼球。然而，这种方法会对下眼睑产生牵拉，瘢痕位置不理想，且瓣之间颜色匹配不佳。我们展示了2例Tessier 4号裂病例和1例多发裂（Tessier 1/13、2/12、3/11号）儿童病例，其具有典型的眼颧和眼口距离缩短。所有3例均采用在眼下方将鼻唇瓣向上翻转90度的方法作为一期手术进行重建。该技术尊重美学单位，并将产生的瘢痕置于面部较不显眼的区域。
