Objective:Using three dimensional magnetic resonance imaging to investigate the differences in velopharyngeal structures and motion between normal resonance adults with repaired cleft palate and without cleft palate, to guide the surgical method of cleft palate repair surgery.Methods:Twelve male adults, including 6 adults with repaired cleft palate (cleft group: age 18-26 years old, average 21.8 years old) and 6 adults without cleft palate (noncleft group: age 19-28 years old, average 23.3 years old) were examined with dynamic and static 3D MRI in midsagittal. 32 velopharyngeal measures including soft palate length, effective soft palate length, pharynx ratio, palate height, levator veli palatini muscle length and thickness were obtained on midsagittal, coronal, and levator veli palatine image plane(oblique coronal image plane)and compared between groups. The correlation test of two times data were carried out by Pearson product-moment correlation coefficient to determine the error size of the measurement result. Two separate sample t-tests was used to compare the two sets of data. Results:All the subjects had no speech abnormalities, and velopharyngeal competence. Two measurements of the r value is 0.789 to 0.925 ( P<0.05), which is twice the measurement error is within the acceptable range. The noncleft group of levator veli palatini muscle form is more fluid, while the cleft group is irregular, the middle line can be observed discontinuous phenomenon, and the levator veli palatini muscle insertion soft palate angle is obviously different. Compared to those without cleft palate, participants with repaired cleft palate had a significantly bigger pharynx wide(23.83±3.48) mm, pharynx deep(29.94±3.52) mm, bone pharynx deep(39.68±3.63) mm, palate length ratio(1.18±0.16), pharynx ratio(0.87±0.91), PVU angle (movement)(105.68±20.54)°, the intravelar segment of the levator veli palatini muscle(13.13±1.00) mm, insertion spacing(13.13±1.00) mm. and the starting angle of the levator muscle(58.0±3.3)°. In contrast, the width of the hard palate(37.5±1.43) mm, soft thicknes(9.48±1.03) mm, soft palate relative extension length (/ts/)(1.09±0.05) mm, the thickness of the levator veli palatini muscle(4.07±0.25) mm, APV angle (movement)(180.51±8.55)° and the starting distance of the levator muscle(52.27±7.08) mm are larger in the normal group, The differences are statistically significant( P<0.05). Conclusions:Measuring the pharyngeal structure with three-dimensional magnetic resonance is feasible, and there are significant differences in the pharynx structure, soft palate and levator veli palatini muscle morphological structure of the adults with repaired cleft palate and without cleft palate. Attention to the anatomical reset of the levator muscle, especially the protection and extension of the the extravelar segment of the levator veli palatini muscle, and the extension of the effective soft palate when the soft flap is separated, should be noted in the early repair of the cleft palate.

Objective:Using three dimensional magnetic resonance imaging to investigate the differences in velopharyngeal structures and motion between normal resonance adults with repaired cleft palate and without cleft palate, to guide the surgical method of cleft palate repair surgery.Methods:Twelve male adults, including 6 adults with repaired cleft palate (cleft group: age 18-26 years old, average 21.8 years old) and 6 adults without cleft palate (noncleft group: age 19-28 years old, average 23.3 years old) were examined with dynamic and static 3D MRI in midsagittal. 32 velopharyngeal measures including soft palate length, effective soft palate length, pharynx ratio, palate height, levator veli palatini muscle length and thickness were obtained on midsagittal, coronal, and levator veli palatine image plane(oblique coronal image plane)and compared between groups. The correlation test of two times data were carried out by Pearson product-moment correlation coefficient to determine the error size of the measurement result. Two separate sample t-tests was used to compare the two sets of data. Results:All the subjects had no speech abnormalities, and velopharyngeal competence. Two measurements of the r value is 0.789 to 0.925 ( P<0.05), which is twice the measurement error is within the acceptable range. The noncleft group of levator veli palatini muscle form is more fluid, while the cleft group is irregular, the middle line can be observed discontinuous phenomenon, and the levator veli palatini muscle insertion soft palate angle is obviously different. Compared to those without cleft palate, participants with repaired cleft palate had a significantly bigger pharynx wide(23.83±3.48) mm, pharynx deep(29.94±3.52) mm, bone pharynx deep(39.68±3.63) mm, palate length ratio(1.18±0.16), pharynx ratio(0.87±0.91), PVU angle (movement)(105.68±20.54)°, the intravelar segment of the levator veli palatini muscle(13.13±1.00) mm, insertion spacing(13.13±1.00) mm. and the starting angle of the levator muscle(58.0±3.3)°. In contrast, the width of the hard palate(37.5±1.43) mm, soft thicknes(9.48±1.03) mm, soft palate relative extension length (/ts/)(1.09±0.05) mm, the thickness of the levator veli palatini muscle(4.07±0.25) mm, APV angle (movement)(180.51±8.55)° and the starting distance of the levator muscle(52.27±7.08) mm are larger in the normal group, The differences are statistically significant( P<0.05). Conclusions:Measuring the pharyngeal structure with three-dimensional magnetic resonance is feasible, and there are significant differences in the pharynx structure, soft palate and levator veli palatini muscle morphological structure of the adults with repaired cleft palate and without cleft palate. Attention to the anatomical reset of the levator muscle, especially the protection and extension of the the extravelar segment of the levator veli palatini muscle, and the extension of the effective soft palate when the soft flap is separated, should be noted in the early repair of the cleft palate.

Objective: To observe the regeneration of palatal fracture in patients with unilateral complete cleft lip and palate. Methods: A total of 35 patients with unilateral complete cleft lip and palate were randomly included as the observation group and 20 with normal teeth as the control group. All the subjects underwent CT with high resolution. Based on the formation of bone bridge, the observation group was further divided into bone bridge formation group and non-bone bridge formation group. The regenerated bone of the bone bridge was measured. The width of the anterior segment, middle segment and posterior segment of the dental arch were measured and statistically analyzed between the observation group and the control group. Results: ①A total of 25 cases with varying degrees of regenerated bone was interconnected to form bone bridge in palatal process, while in the remaining 10 cases, bone was regenerated, but not connected to form bone bridge. ②The width of the middle section of the arch in the observation group was greater than that in the non-bone bridge formation group. The width of each segment in the observation group was less than that in the control group. Conclusions Bone was regenerated to various extent in the palate after cleft palate. The formation of bone bridge is beneficial to the development of dental arch.

Objective To investigate the efficiency of rapid prototyping technology in repair of complex orbital injury.Methods The study involved 16 cases of complex orbital injury.Based on three-dimensional orbital reconstruction,the rapid prototyping technology was used to produce a l∶ 1 scale three-dimensional physical model.Treatment plans were developed with the aid of surgical simulation on the model and were practiced clinically.Results The model was created successfully in the study.Surgical incisions were all healed initially.Satisfactory facial shape,symmetrical orbit,normal ocular motility,and disappeared diplopia were achieved over 3 months to 3 years of follow-up.Conclusion A rapid prototyping model gives solid and accurate display of orbital three-dimensional anatomical structures and their interrelation and hence offers a vital basis for accurate understanding of malformation condition and rational design of surgical plans.

Objective To evaluate the application of modified Abbe flap in repairing moderate defects of the upper lip and time point to divide the pedicle.Methods Classic Abbe flap was modified in its design,pedicle cutting and dividing time,which was used to repair moderate defect of the upper lip in 12 cases.Surgery was divided into two phases:one with modified Abbe flap surgery was performed for the combined nasal deformity repair simultaneously,and then the pedicle was divided 9days after surgery.Results 12 patients underwent modified Abbe flap.No vascular complications were found in these flaps.Upper lip shape was well and satisfactory functional recovery,corresponding improvement in nasal appearance.Conclusions The surgery that the modified Abbe flap with the pedicle is divided 9 days after surgery is very simple.On one hand,it greatly improves the patient's appearance and function of the upper lip,improve the overall shape of midface,on the other hand,dividing pedicle time is significantly shorter than in the past,specially reducing the suffering of patients and duration.It is particularly suitable for unilateral and bilateral cleft lip of the upper lip on secondary moderate deformities and combined nasal deformities.

Objective To investigate the practical anatomy and clinical applications of the lateral sural nerve-lesser saphenous vein vascular plexus island flap with median sural nerve preserved.Methods Ten lower limbs injected with color red latex and 20 fresh limbs were observed.Based on anatomical studies,the island flap pedicled with the vascular axis of lateral sural nerve and lesser saphenous vein was designed for clinical application in 63 cases.In procedure,the median sural nerve were preserved in donor site and the distal end of the lesser saphenous vein were not ligated.Results The accompanying arteries formed a favourable vascular plexus around the nerve and the vein,lied along the lateral sural nerve and the lesser saphenous vein and nourished the skin through cutaneous branches.The distance of the lateral ankle to the confluent of lateral and median sural nerve was (8.5± 0.8) cm.63 patients with soft tissue defects in the distal leg and foot were repaired.Their appearance and function were satisfaction without feeling lose in the heel and lateral side of the foot.Conclusions The lateral sural nerve-lesser saphenous vein vascular island flap is a reliable source of soft tissue to cover defects in the lower leg and foot.This flap has sufficient blood supply and high survival rate without the sacrifice of the median sural nerve.

Objective To explore the method of treatment of sunken cheek deformity.Methods The longitudinal platysma-faseial flap was overturned 180 degree upward,the flap's pedicle located in the margin of mandible,and then combined with abdominal dermis fat graft to form as a sandwich,which filled in the sunken area of face.Results Five patients were treated with this method from 2003 to 2007,and satisfactory results were gained but only mild absorption was found in the transplanted tissue area during followed up for 3 months to 3 years.Conclusion Platysma-fascial flaps survive easily with rich blood supply and strong anti-infection,and are also easy to incise and operate as well,which,together with free abdominal dermis fat flap,could increase the amount of the needed tissue.It is a better approach to repair the sunken cheek deformity and in particular suitable for the more serious deformity in patients with sunken cheek.

Objective To explore the design of forehead flap pedicled with supratrochlear artery and shift way for aesthetic reconstruction of the nose without secondary operations for debulking.Methods Origin of blood supplies and the distributed situation of the vessel in the frontal region were studied through the internal carotid artery and the external carotid artery X-ray angiography.The frontal region existed polyphyletic blood supplies,the supratrochlear artery and the supraorbital artery set out many branches,respectively,in the level of frontal bone eyebrow plane.One constant,thicker horizontal branch from the superficial temporal artery obviously extended to the forehead median.The branches from three blood vessels mentioned above constituted the network of artery adequate in the muscle and the subcutaneous tissue level,assumed the three-dimensional distribution in the forchead region.The nasal reconstruction had been done for 9 patients with the oblique orientation designed forehead flap by using one side of supratrochlear artery as the pedicle and cutting skin paddle with the same or the opposite side of forehead flap.Results All flap survived completely with the restoration of nasal shape and functional satisfaction.Conclusion The forehead oblique orientation flap pedicled with one side supratrochlear artery is nourished by the rich blood supply.The flap can be split into two flaps:a myofascial flap and a skin flap in far part.Myofascial flap may be the good package of cartilage framework,and simultaneously split skin flap is favorable of the shape models.The flap may satisfy the demand of the nasal restoration.

OBJECTIVETo introduce a method of repairing facial tissue defects caused by various factors.

METHODSThe reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.

RESULTSThis fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.

CONCLUSIONThis fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Surgical Flaps

Objective To investigate the method of repairing moderate or severe full defect of eyelid. Methods According to eyelid structure and the defect size, the two composite eyelid flaps were designed beside defect based on the arterial arch of the palpebral margins. If the defective area was too large, the lateral composite flap may be extended to lower or upper eyelid at the outer canthus, then the two flaps were propelled to the defective region to repair it. Results Eleven patients had been cured with this method since 1998. The largest length of eyelid defect was 1.7cm, and the smallest was 0.8cm. All defects exceeded 1/3 length of the upper or lower eyelid. All composite flaps survived completely without any complication. The appearance of the repaired eyelid was satisfactory. Conclusion Using the composite flap to repair the full moderate or severe full defect of eyelid is a new and effective method. It can not only provide enough tissues to repair large full defect of the upper or lower eyelid and to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities, and the blood supply of the composite flap is reliable. The method is worth employing routinely.