OBJECTIVETo classify the patients with cleft lip and palate who need orthognathic surgery and to propose the corresponding operations.

METHODSFrom January 2005 to May 2015, 121 patients with cleft lip and palate diagnosed as maxillary retrusion were treated by orthognathic surgery. Inclusion criteriar: (1) male aged over 16, female aged over 14; (2) diagnosed as non-syndromic cleft lip and palate without systemic disease and other genetic diseases; (3) without previous orthodontic and orthognathic treatment; (4) having no other craniofacial malformation. Maxillary features and repaired types were recorded.

RESULTS93 patients were included and divided into two categories depended on the dental crowding. Class I: the teeth quantity and bone quantity is coordinated, space analysis ≤ 4 mm (mild dental crowding). The forward distance of maxillary less than 6 mm was defined as Class I a (36 cases) more than 6 mm as Class I b (28 cases). Class II: the teeth quantity and bone quantity is not coordinated, space analysis > 4 mm ( moderate or severe dental crowding). After the simulation of distraction osteogenesis, the anterior crossbite was corrected defined as Class II a (23 cases), not corrected defined as Class II b (6 cases). Class I a were corrected by conventional orthognathic surgery. While Class I b were corrected by Le Fort I maxillary advancement using distraction osteogenesis. Class II a were repaired just by anterior maxillary distraction. While Class II b need to combine conventional orthognathic surgery with anterior maxillary distraction. All the patients were satisfied with the treatment effect.

CONCLUSIONSThe patients of cleft lip and palate with maxillary retrusion who need orthognathic surgery can be classified as the method mentioned above, and then choose the appropriate operations.

Adolescent ; Adult ; Cleft Lip ; complications ; Cleft Palate ; complications ; Female ; Humans ; Male ; Maxilla ; Osteogenesis, Distraction ; Osteotomy, Le Fort ; Retrognathia ; classification ; surgery

Objective: The cadaveric specimens stained with iodine-potassium iodide can show the fine structure of muscles by Micro-CT scanning. A specimen with cleft palate was scanned using this technique to explore the relationship between the muscle fibers of pharyngeal muscles in order to guide the muscle reconstruction in cleft palate repair, so as to understand the lingual pathology secondary to cleft palate. Methods: One unclaimed 28-week aborted stillbirth, diagnosed as Ⅱ-degree cleft palate, was dissected.The anatomic structure between orbital floor plane and mouth bottom plane was saved, and soaked in 4% for maldehyde for 8 hours. Thereafter, the subject was soaked in 3.75% iodine-potassium iodide for 7 days for staining. The stained specimens were scanned with Micro-CT. The muscle fibers were drawn in the exported DICOM images, for three-dimensional muscle reconstruction. Results: The main muscles of velopharynx were located in the tomographic image and the three-dimensional reconstructed model, including: the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle, the palatoglossus muscle, and the upper part of the superior pharyngeal constrictor. Some local anatomical features of the muscles were also found: (1)The tensor velipalatini has a branch ended at the lateral pharyngeal wall.(2)The superior pharyngeal constrictor has multiple connections with the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle.(3)There was no obvious muscle fiber crossing between the internal muscles of the cleft palate. The muscle of uvula was not found either. Conclusions With the application of high-resolution Micro-CT technology, new branches of pharyngeal muscles and crossings of muscles can be recognized. In the cleft palate specimen, the main functional muscles of pharyngeal are mainly associated with superior pharyngeal constrictor. The muscles in the palate and the pharynx are interrelated and form a three-dimensional " velopharyngeal muscle complex" .

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

Objective: This study is to repair nostril sill deformity in the cleft lip patients by reconstructing the first auxiliary muscle tension line group and to assess the therapeutic outcome. Methods: 437 cleft lip patients with nostril sill deformity underwent the surgery from January 1, 2012 to November 1, 2016.They were treated using the technique of first auxiliary muscle tension line group reconstruction to repair the deformity. Aesthetic correction evaluations were rated by the GAIS. Random digit was used to randomly select 24 patients during the follow-up for three-dimensional measurement and analysis. The preoperative and postoperative symmetry of the nostril sills were evaluated by paired t test. Results: Mucosal ischemia or wound infection occurred in 11 cases, left obvious scar on the nostril floor. Surgical incisions of the other patients were primary healing. After 6 months to 3 years follow up, GAIS questionnaires of 378 patients demonstrated that 84% patients reported great or moderate improvement of nostril sills. Three-dimensional measurements of 24 patients suggested that there were no significant differences of the nostril sill and the nasal ala between the cleft side and the normal side. Conclusions First auxiliary tension line group reconstruction, which is to restore biomechanical balance rather than merely increase muscle volume, is an effective method of nostril sill repair in the cleft lip patients. Post-operatively, the patients achieved a stable and natural nostril sill, a middle columella, as well as a narrowed nasal ala.

Objective To explore the clinical outcome of anterior palatal fistula repair using alveolar ridge approach .This method provides a good aesthetic effect .Methods Alveolar ridge approach was utilized to repair anterior palatal fistula and correct oronasal fistula .Results a total of 25 cases of palatal fistula were repaired .The gum approach for repairing palatal fistula is a good choice without scar formation restricted mouth opening , scar contracture , or masticatory disorders , almost reaching to an ideal state in an anatomical and physiological way .Conclusions the application of alveolar ridge approach for palatal fistula repair is a safe and reliablemethod with high survival rate , which could provide an acceptable aestheticresult .

Objective To investigate the nasolabial muscle anatomy and biomechanical characteristics.Methods Micro-computed tomography scan was performed in 8 cases of spontaneous abortion fetus lip nasal specimens to construct a three-dimensional model.The nasolabial muscle structure was analyzed using Mimics software.The three-dimensional configuration model of nasolabial muscle was established based on local anatomy and tissue section,and compared with tissue section.Three dimensional finite element analysis was performed on lip nasal muscle related biomechanics and surface deformationin Application verification was carried out in 263 cases of microform cleft lip surgery.Results There was close relationship between nasolabial muscle.The nasolabial muscle tension system was constituted,based on which a new cleft lip repair surgery was designed and satisfied results were achieved.Conclusions There is close relationship among nasolabial muscle in anatomy,histology and biomechanics.To obtain better effect,cleft lip repair should be performed on the basis of recovering muscle tension system.

Objective To explore the clinical outcome of anterior palatal fistula repair using alveolar ridge approach .This method provides a good aesthetic effect .Methods Alveolar ridge approach was utilized to repair anterior palatal fistula and correct oronasal fistula .Results a total of 25 cases of palatal fistula were repaired .The gum approach for repairing palatal fistula is a good choice without scar formation restricted mouth opening , scar contracture , or masticatory disorders , almost reaching to an ideal state in an anatomical and physiological way .Conclusions the application of alveolar ridge approach for palatal fistula repair is a safe and reliablemethod with high survival rate , which could provide an acceptable aestheticresult .