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目的探讨榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形的疗效。方法 2009年1月-2011年8月,收治43例单侧唇裂修复术后继发人中嵴畸形患者。男23例,女20例;年龄18～31岁,平均23.6岁。左侧26例,右侧17例。唇裂采用MillardⅠ式修复15例,MillardⅡ式修复28例。唇裂修复术至此次手术时间为15～30年,平均21.7年。术中切取双侧口轮匝肌肌瓣,水平分成上、下两层;双侧下层肌瓣相互重叠缝合,上层肌瓣形成榫卯型结构,缝合于皮下。结果术后患者切口均Ⅰ期愈合。40例患者获随访,随访时间6～34个月,平均13.4个月。双侧人中嵴隆起、对称,人中凹形态接近正常,上唇动态效果满意。术后6个月38例明显改善,2例改善不明显。结论榫卯型口轮匝肌肌瓣手术操作简便,修复单侧唇裂术后继发人中嵴畸形能较好恢复解剖结构,术后获得良好上唇外形和功能。
Objective To investigate the efficacy of tenon flapping orbicularis muscle flap in the repair of secondary human ridges deformity after unilateral cleft lip repair. Methods From January 2009 to August 2011, 43 patients with secondary crista malformation after unilateral cleft lip repair were treated. 23 males and 20 females; aged 18 to 31 years, mean 23.6 years old. 26 cases on the left and 17 cases on the right. Cleft lip cleft with Millard Ⅰ 15 cases, Millard Ⅱ repair 28 cases. Cleft lip repair surgery to the time of 15 to 30 years, an average of 21.7 years. Intraoperative bilateral orbicularis oris muscle flap, the level is divided into upper and lower two layers; bilateral lower muscle flap superimposed on each other, the upper muscle flap to form tenon-ditch-type structure, sutured in the skin. Results Postoperative incision healed in all cases. Forty patients were followed up for 6 to 34 months with an average of 13.4 months. Bilateral crest uplift, symmetry, the human concave shape close to normal, the upper lip dynamic effect satisfaction. In the 6 months after operation, 38 cases improved obviously and 2 cases did not improve obviously. CONCLUSION: The operation of tenomyelous orbicularis oris muscle flap is simple and convenient. It can restore the anatomical structure better by repairing the secondary crista deformity after unilateral cleft lip repair, and obtain the shape and function of upper lip well after operation.