Objective To explore the method to correct nasal deformity of the bilateral complete cleft lip and to eveluate the benefits of this teachnique.Methods Sixteen patients with the bilateral complete cleft lip were consecutively chosen to correct the nasal deformity of the bilateral complete cleft lip.We performed an open approach to facilitate alar cartilage manipulation while repairing the bilateral complete cleft lip,and elevated the prolabial flap for reconstructing the continuity of orbicularis oris musele artery by anatomizing and protecting the prolabial-columellar artery.Nasal columella length and wideth,nasal wideth,ratio of nasal length to face length,ratio of nasal wideth to the distence of nasolabial angle were analyzed after a minimum of 10 years after surgery.These were compared with those in a normal,age-matched control group.Results Appreance of nose and lip of 16 patients after surgery were satisfying and long-term results were good by following-up for 10 years.Columellar length and ratio of nasal length to face length were not significantly different from that of the control group.Nasal wideth,columella wideth,tip projetion and nasolabial angle were all significantly greater in the cleft group than the normal (P＜0.05).Conclusions Prolabial flap manipulation is a safe approach by using anatomizing the columellar-labial artery.This teachnique is effective and yields good long-term results.

Objective To evaluate the effects of micro-screw on the intrusion of lower incisors and the leveling of curve of Spee in the process of orthotherapy.Methods Fifteen patients (5 males,10 females) with deep-bite were selected,aged from 11.3 to 28.8 years,with average of 17.2 years.All of them were Angle Class Ⅱ Classification 1 malocclusion and had a curve of Spee larger than 3 mm.Orthotherapy of extraction was adopted for the first premolars of two upper mandible and second premolars of two lower mandible.All these patients had micro-screws implanted at root apex area between lower lateral incisor and canine bilaterally,and when the 0.457 mm× 0.635 mm (0.018 in ×0.025 in) Ni-Tisquare wire was internalized,the strength of intrusion from micro-screws was used.Lateral cephalometric radiographs were taken before loading the micro-screw and immediately when the curve of Spee was leveled.Two linear and two angular measurements were selected for cephalometric analysis.Results The following results were noted: the lower incisors were significantly intruded for a mean of (4.10±0.98) mm; the mandibular molars were not significantly extruded for a mean of (0.91±0.69) mm; some lower incisors proclined and some lower incisors retroclined for a mean of (-0.09±4.12)°.After bite opening,the mandibular plane angle was minimally altered for a mean of (0.25±0.70)°; the ratio of lower incisor intrusioin to lower molar extrusion was 4.5: 1.0.Conclusions The combined use of micro screw with Ni-Ti wire is capable of enhancing the intrusion of lower incisors and leveling the curve of Spee,and it has minimal side effects on the posterior teeth.

Objective To investigate the biomechanical changes of internal maxillary distraction with fixation between cleft palate.Methods Three-dimensional FEM models of LeFort Ⅰ osteotomy and soft tissue in CLP maxillary complex were established.Two different conditions were simulated:one was the cleft palate connected by a titanium plate,and the other was the cleft retained.Internal midface distraction which applied in clinic were simulated.Fixation points of the distraction devices on the LeFort Ⅰ osteotomy complex were advanced by 10 mm in the direction of frontage.Biomechanical changes for different conditions were investigated by means of finite element analyses.Results LeFort Ⅰ osteotomy of maxillary complex area in CLP was advanced.Constrictions occurred in alveolar crest and palate,when the cleft was retained.Constriction of alveolar crest and palate was not obvious,when the cleft palate was connected by a titanium plate.There were no differences between sagittal and vertical displacement to internal distraction in LeFort Ⅰ osteotomy.Clockwise rotation occurred in vertical direction.Conclusions Internal maxillary distraction with fixation between cleft palate could avoid constriction of alveolar crest and palate.It provides the options and reference to the surgical plans.

Objective To discuss the effect of transplanting autogenous rib cartilage in correction of short and upwardly rotated nose.Methods A piece of autogenous rib cartilage was transplanted into the front of nasal septa to lengthen it,leading to the nasal tip moving forwards and correcting the short and upwardly rotated nose.For low nose cases,simultaneous implants was used into the nasal back.Results The nasal tips were prolonged 0.75 cm on average after operation in 56 patients with short and upturned noses.The nasolabial angle and extent of nostril exposure were normal after operation.The operational consequences were fine in 54 patients,while 2 case were not satisfactory.Efficacy was stable during one year follow-up.Conclusions This method is reliable,and it can be recommended in rhinoplasty of patients with short and upwardly rotated nose.

Objective To explore the methodology of suturing the upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap to the levator aponeurosis,simulating the mechanism of fibers from the levator aponeurosis to the dermis in natural double-eyelid in blepharoplasty.Methods Pretarsal orbicularis myocutaneous flap was harvested.Dissection between the orbital septum and the levator aponeurosis was performed originating from the upper margin of the tarsi until to the levator muscle.The upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap was sutured to the levator aponeurosis.The lower skin margin to the orbital septum to the upper skin margin was sutured interruptedly.Patients with medial epicanthus were performed epicanthoplasty at the same time.Results 136 eyes in 68 patients were performed with double-eyelid blepharoplasty using this method.62 patients were followed-up for 1 month and 53 patients were followed-up for 3 months.They all reported satisfactory aesthetic results.Conclusions Double-eyelid blepharoplasty using this method accords with the physiological mechanism in natural double-eyelid.Postoperative double-eyelid is natural with little tumefaction.This method can avoid double-eyelid fold retraction and multi-fold occurrence.

Objective To study the asymmetry of the soft tissue thickness of upper eyelids in Shanghai female undergraduates undergoing double eyelid surgery.Methods Data were collected in 565 female students from Shanghai universities.Before surgery,oblique sagittal view images of the upper eyelids by 3.0T MRI were obtained and the following parameters were measured: soft tissue thickness at upper tarsal plate margin and upper central tarsal plate,sub-eyebrow and intra-orbital septum fat pad areas,and whole upper eyelid soft tissue areas.The resected orbicularis and intra-orbital septum fat were weighed by a highly accurated electronic balance.The eyelid asymmetry index (EAI) was calculated.Results The MRI (U/U2) central tarsal plate soft tissue thickness were:4.46±0.90 in the right side and 3.78±1.01 in the left; the intra orbital septum fat areas were:172.33±49.29 in the right and 136.34±37.42 in the left; the whole tissue areas were: 697.13±146.99 in the right and 500.66±158.87 in the left (P＜0.01 for all).The weight of the resected orbicularis oculi muscle and intra orbital septum fat pad were (0.18±0.05) g and (0.17±0.06) g for the right side,and (0.15±0.04) g and (0.06±0.05) g for the left side (P＜0.01 for all),respec tively.The orbicularis EAI was 0.17±0.06,and the intra orbital septum fat EAI was 0.41 ±0.08.Conclusions The asymmetric phenomenon of the upper eyelids' soft tissue thickness is commonly found in the Shanghai female undergraduates,and the main manifestation is that orbicularis and intra orbital septum fat in right side are thicker than that in the left.

Objective To evaluate the surgical procedures and clinical results to treat the bleph arochalasis.Methods A series of 43 blepharochalasis in 23 patients were surgically treated.A double eyelid fold incision was made.Surgeon clippd redundant skin of upper eyelid with forceps,so that would be excised was marked out.Then redundant skin and muscles as well as hernia septal fat were removed.The lacrimal glands were found and repositioned into lacrimal glands fossa behind superolateral orbital rim.We choose different methods to perform plastic operation in 23 cases of blepharochala sis according to different topographic anatomic characteristics.Results Postoperatively,not only the patients recovered in a followed-up period of 1-3 years,but all lacrimal glands were normally rep soitioned.Conclusions These methods are effective in patients with blepharochalasis and meet the cosmetic demands.Good clinical results in both function and appearance are achieved.

Objective To explore more satisfactory results in correcting the aesthetically short nose combined with low and blunt nasal tip by using autologous cartilage grafts.Methods External rhinoplasty approach was preferred.Nasal septal cartilage and auricular cartilage or rib cartilage of patients were adopted,as necessary,various shapes of grafts were carved,such as septal extention graft,columella strut and shift graft.Then we used these autologous cartilage grafts with suture and removal techniques to correct the aesthetically short nose combined with low and blunt nasal tip.The length of the nose (n-prn) and the projection of nasal tip (sn-prn) were measured before and after the operation.Paired t-test was adopted to evaluate the results.Results Thirty-one patients accepted the nasal tip rhinoplasty with autologous cartilage whose nasal tip was over rotation,blunt and low.All the patients were followed up for 3 months.Thirty patients satisfied with the results,accounting for 96.7 ％ of the total.()ne (3.3 ％) patient dissatisfied with the result because of postoperative asymmetry nostrils.Nose length before and after surgery was significantly different (P＜0.05).Nasal tip projection before and after surgery was also significantly improved (P＜0.05).Conclusions It is an effective method to use autologous cartilage graft for correcting the aesthetically short nose combined with low and blunt na sal tip,with low complications.

Objective To explore the causes of secondary breast deformity after breast conservative therapy and its preventive methods.Methods 30 cases were selected from the patients with secondary breast deformity of more than 1 year after breast conservative therapy,and more than half a year after radiotherapy and chemotherapy,and no local recurrence and distant metastasis occurred.After cicatrectomy and contracture loose solution,different methods were used according to varying degrees of the secondary breast deformity to reconstruct and repair the deformity.Results Three reconstructive methods were conducted.Local mammary flaps were used in 7 patients,latissimus dorsi myocutaneous flap in 21 patients,and transverse rectus abdominal musculocutaneous flaps in 2 patients.The shape and feeling were satisfactory in 30 patients with reconstructive breasts,in which 23were excellent (76.7 ％),and 7 were good (23.3 ％).All the patients were followed-up for average 2.5 years,and they were survived without tumor recurrence.Conclusions The secondary breast deformity after breast conservative therapy could be effectively prevented,and successfully reconstructed and repaired with different procedure according to varying degrees of the secondary breast deformity.As a result,the shape and feeling of reconstructive breasts are satisfactory.

Objective To introduce a surgical method for treatment of severe gynecomastia.Methods After designing double rings and ectomizing epidermis between two rings,a supra-medialis derma mammary pedicle of the nipple and areola was formed,most of the gland and fatty tissue was ectomized,the pedicle was fixed with the sarcolemma,and the two rings were sutured together.Resuits There were no severe postoperative complications.Following-up of 9 cases (18 sites) for 6 to 24 months showed symmetrical and satisfactory contour.Conclusions The breast reduction with doublering supra-medialis pedicle can be an effective procedure of severe gynecomastia,in which the supramedialis pedicle can ensure the blood supply of nipple and areola and avoid late mastoptosis.