Repairing unilateral incomplete cleft lip functionally and sub-regionally with modified micro-triangular skin flap and orbicularis oris muscle flaps
10.3760/cma.j.cn114453-20231009-00068
- VernacularTitle:改良皮肤微小三角瓣联合口轮匝肌瓣功能性分区重建修复单侧不完全性唇裂
- Author:
Jiansheng DIAO
1
;
Lin HE
;
Xueyuan YU
;
Xiangyu LIU
;
Huicong DU
;
Maoguo SHU
Author Information
1. 西安交通大学第一附属医院整形美容颌面外科，西安 710061
- Keywords:
Cleft lip;
Reconstructive surgical procedures;
Micro-triangular flap;
Orbicularis oris muscle
- From:
Chinese Journal of Plastic Surgery
2024;40(2):143-150
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of repairing unilateral incomplete cleft lip functionally and sub-regionally with modified micro-triangular skin flap and orbicularis oris muscle flaps.Methods:A retrospective study was conducted in the patients with unilateral incomplete cleft lip, who underwent repair at Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from April 2020 to February 2023. Surgical landmarks were fixed according to the anatomical structure of non-cleft side. Short straight skin incisions were designed along the philtral column. A micro-triangular flap was designed above the vermilion margin of the affected lip, which was inserted into the contralateral lip peak to lower the lip peak and lengthen the philtral column. The orbicularis oris muscle was reconstructed with five muscle flaps in three areas to create a good sub-structure of the upper lip and the nasal floor. The vermilion tubercle and philtral column were reconstructed. Deviation of nasal columella was corrected and the nasal floor was elevated. The outcomes were assessed through subjective evaluation and objective anthropometric measurements.(1) Subjective outcomes were assessed by two plastic surgeons together who were not included in this study. The following parameters were assessed: scar appearance, Cupid’s bow continuity, lip pick height, alar base width, nostril symmetry, philtral ridge contour. Each parameter was graded from 1 point (poor), 2 points (average), or 3 points (good). (2) Objective measurements were taken by one plastic surgeon who was not included in this study using the Image-Pro Plus 6.0. Measurements were included bilateral vermilion thickness, bilateral length of lip pick to cheilion, bilateral philtral column length, bilateral length of Cupid’s pick to ala nasi, bilateral alar base width. Asymmetry ratio = |non-cleft counts-cleft counts|/non-cleft counts×100%, and a value closer to 0 would mean the less different, the more symmetrical. Statistical analysis was performed using descriptive methods. Non-normal distributed measurement datas were expressed by M( Q1, Q3). Results:A total of 32 patients of unilateral incomplete cleft lip were enrolled, including 19 males and 13 females, aged 3-18 months. All patients were primary healing, and no serious complications (i.e., infection, hematoma, wound dehiscence) occurred. The postoperative follow-up time was 6-24 months. The patients were satisfied with the results, including favorable red lip contour, good continuity, obvious vermilion, cubical philtrum column, good symmetry of bilateral structure and sub-structure and light scar. The overall score of the subjective evaluation was 2.66 points. Cupid’s bow continuity got the highest score(2.84 points), and nostril symmetry got the lowest score(2.38 points). Objective measurements indicated excellent parameters were bilateral alar base width [2.60%(1.02%, 7.08%)] and bilateral philtral length[3.95%(2.03%, 5.98%)].Conclusion:Repairing unilateral incomplete cleft lip functionally and sub-regionally with modified micro-triangular skin flap and orbicularis oris muscle flaps can create a good sub-structure of the upper lip contour, and bring a significant improvement in the upper lip and the nasal floor symmetry, which is an effective method for incomplete unilateral cleft lip repair.
