The fine anatomy of the nostril sill has a great deal of variability among the individuals.The nostril sill deformity is included in the nasal deformities after cleft lip repair,which has been paid more attention.In this article,we review the anatomy of the nostril sill,the features of nostril sill in cleft lip deformities,and the techniques of the nostril sill deformity repair.

Objective To introduce the method of lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril.Methods We adopted the method of using the skin cartilaginous tissue flaps on the superior border of bilateral nostril associated with alar cartilages reduction to lengthen the columella in 40 patients with severe secondary bilateral cleft lip nasal deformity.All patients were followed up for 5-28 months,with an average period of 15.3 months.The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results All the 40 patients had achieved satisfactory lengthening of columella and there were no major complications.The questionnaire results showed 36 patients with excellent and 4 patients with good.Conclusions Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril is a relatively simple and safe method with good effect.

Objective To investigate the surgical methods and effect of double-cut nasolabial muscle directional three-dimensional reconstruction on the secondary deformity of unilateral cleft lip repair.Methods We first increased a contralateral vermilion secondary incision based on the nasolabial muscle directional three-dimensional reconstruction, without damaging the contralateral white lip skin, via suturing both sides of nose wings bundle of nose outside corner under the columella muscle, and overlapping suturing both sides of the orbicularis muscle flap, and then rebuilt and took shape of the nest and the crest.Results All incisions healed well in 18 patients, all nasal deformities were corrected better than the traditional methods, with the nasal base plump, the nasal sill formed close to the contralateral side, and rebuild the philtrumdimple and philtrum crest, with clear appearance and symmetrical form.A good appearance was obtained on the both sides of nostril, nasal base and the nasal sill, and the effect of preoperative design achieved.Conclusions Both sides of the nostrils size, nasal sill and shape are almost perfectly symmetrical, and the double-cut nasolabial muscle directional three-dimensional reconstruction is suitable for repairing the secondary deformity after unilateral cleft lip repair.

Objective To investigate features of maxillary morphology in unilateral cleft lip and palate (UCLP) with maxillary retrusion and the dissimilarities of retruded maxilla.Methods Craniofacial measurements were done in 32 UCLP adult patients with maxillary retrusion (GC), 24 adult patients in class Ⅲ (GⅢ), and 32 healthy adults (GN).The CT slice data was reconstructed into a 3D video model and measured by Mimics 16.01.Results The maxillary volume (GM) and the volume composed of maxilla and maxillary sinuses (GT) were significantly smaller (P<0.05) in GC.The anterior and posterior parts of the maxillary length (A1-P3M⊥CP and P3M-P6M⊥CP) and overall maxillary length(A1-P6M⊥CP)at the dental level were all significantly reduced (P<0.05).There was no significant difference of the distances of A1⊥CP between the GC and GⅢ groups, while the P3M-CP and P6M-CP in the GⅢ group were significantly shorter (all P<0.05).The anterior and overall maxillary length at the dental level (A1-P3M⊥CP and A1-P6M⊥CP) in the GC group was significantly smaller than that in the GⅢ group (all P<0.05).Conclusions The decreased prominence of maxillary complex could be caused by the shortened maxillary length in UCLP patients;the posterior position of the maxilla is more obvious than that of GC group in class Ⅲ patients.

Objective To develop an in vitro model for cranial suture of neonatal SD rat. Methods The parietal hones with the sagittal suture were removed from SD rats (19-days old) for organ culture. In the experimental group, tensile force 3.92×10~(-3) N (0.4 g) was applied by helical springs, whereas no tension (0 N) was set in control group. These explants were observed under inverted microscope. At the end of the incubation period for 24 hours, general conditions were observed under inverted microscope and histological conditions were observed after hematoxylin and eosin stain. Results Under inverted micro-scope, sutures had no obvious changes in control group, whereas sutures were enlarged gradually in the experimental group. With histological observation, sutures developed normally in control group, but in experimental group, osteohlasts and capillary vessels proliferated actively in the suture. Conclusions In vitro model of cranial suture can be cultured and grown successively.

Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip.We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap.Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities.The central defects usually occurred in these patients.The defects were reconstructed partially or completely according to the severities of the defects.The operative procedures were as follows: The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided.Then the partial-thickness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect.Results All 98 musculomucosal pedicle flaps were viable.The upper lips were reconstructed according to the severities.Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity.It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities.

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 To detect differentially expressed genes between human normal skin and photoaging skin, and to investigate the molecular and biological mechanisms of human skin photoaging at transcriptional level. Methods Full-thickness skin specimens were obtained during full-face rhytidectomy from sun-exposed (anterior ear skin) and sun-protected (retroauricular skin) sites of 6 patients with facial photoaging from 2007 to 2008. Genomic microarray analysis was conducted to identify differentially expressed genes between the two groups of specimens followed by gene-cluster analysis. Results The normalization of microarray data showed that the number of differentially expressed genes was 2163 between skin samples from sun-exposed and sun-protected sites in one patient, significantly higher than that in the other 5 patients (less than 200);therefore, the data from the patient with 2163 differentially expressed genes were excluded from further analysis.Totally, 172 differentially expressed genes were identified with Beadarray chip, including 99 up-regulated genes and 73 down-regulated genes. Based on Genebank research, 118 functionally classified genes werefound, which were associated with a series of biological processes, including cell adhesion, receptor regulation,signal transduction, metabolism, and so on. Conclusions There are a lot of differentially expressed genes between human photoaging skin and normal skin. Rhytidectomy may be associated with the differential expression of skin photoaging-related genes.

We are no longer entangled in the anatomical resetting of the labial-nasal muscle itself, but the sight to the muscle fiber level, to study the relationship between the muscle fiber force line and the labial-nasal shape. In the past ten years, we focused on the lip of nasal muscle fiber anatomy, imageology and biomechanics, carried out a series of research works, realized the three-dimensional (3D) visualization of small labial-nasal muscle fiber, established configuration models of normal and cleft lip with nasal muscle fibers, and put forward the hypothesis of naso-labial muscle tension band. According to the biomechanical parameters of lip nasal muscle, cartilage, skin and subcutaneous tissue, we initially established a biomechanical model elaborating the relationship between labial-nasal muscle tension lines and surface morphology; we summed up three muscle tension group which determines labial-nasal contour, explained the biomechanical mechanism in cleft lip and various lip nasal deformities, and realized the possibility to freely change the 3D labial-nasal contour by lip nasal lip nasal muscle tension theory; Finally we carried out clinical validation in clinical treatment of cleft lip, achieved the effect of detail cleft lip repairing.

Objective To investigate a new method which could not only avoid the extrusion of the silicon implant, but also be benefit for the reconstruction of nasal tip and alar during nasal augmen-tation procedure. Methods Folded lower lateral cartilage flap combined with silicon implant was ap-plied for nasal dorsal augmentation and reconstruction of nasal tip and alar with its unique character at the same time. Results 12 cases were all primary healing, without infection, extrusion of implant and other complications. One month after operation, the projection of nasal tip was increased, which had better delicate and definite shape, natural appearing tip adding contour and height to nasal tip, pleas-ant definition. Conclusions Folded lower lateral cartilage flap combined with silicon implant is an ef-fective method to decrease the incidence of extrusion, when we want to have a little over-projected na-sal tip with prosthesis. It is also helpful for reconstructing the nasal tip and alar with its unique char-acter.