Operative design of unilateral cleft lip repair
Design of line segment Design of flap sharp
Rectangle flap Triangle flap
Upper triangle flap Lower triangle flap
Anatomy of normal lip
Artery of normal upper lip
Natural position of the lip
• Loose upper lip • Eversion of its lower portion • Over and slightly in front of the lower lip
• Reduce the width of the cleft • Molds the maxillae into better alignment
while stalling for catch-up growth and pacifying t is carried out at about 3 to 5 weeks and left to work for about 6 month
Unilateral cleft lip
Anatomy
• Normal lip anatomy • Cleft lip anatomy
Normal lip anatomy
• Alar base • Nostril sill • Philtrum column • Philtrum dimple • Vermilion tubercle • Arch of cupid’sbow • White skin roll of mucocutaneous junction
• Columella is short and obliqued to norm al side
• Alar base always showed wide and flat
Anatomy of unilateral incomplete cleft lip
Anatomy of unilateral complete cleft lip
• At this operation as much of the posterior soft palate as possible is united to achieve posterior molding
• Early coordination with the posterior pharyngeal musculature
唇 裂 修 复 术 后 一 年
Incomplete unilateral cleft lip
Unilateral Complete Cleft Lip
Unilateral Complete Cleft Lip
Incomplete unilateral cleft lip repair
Incomplete unilateral cleft lip repair
7
常见情况：常见完全性唇裂患侧唇峰下降不足或过度
理论错误：裂隙两侧切口长度相等的条件
a
b
b a a’
b’
A B
A B
长庚式旋转推进法（罗慧 夫）
华西口腔医院唇腭裂外科
问题的提出
切口长 度
切口形式
切口长度 切口位置 切口形式
Millard et al
华西法
Computer aid operative design
口轮匝肌的脱套式解剖
梯式旋转下降法与旋转推进法的区别
术前
术后
J Plast Reconstr Aesthet Surg 2009,63(2):277-281
Complete unilateral cleft lip repair
唇 裂 修 复 术 后 一 年
唇 裂 修 复 术 后 一 年
• Point 9: the midline of the columella
The criteria for a satisfactory cleft lip repair
• Accurate skin, muscle and mucous membrane union • symmetrical nostril floors and symmetrical nostril • Symmetrical vermilion border
O’ O”
A
A’ A”
几何学原理 1 示意图
0
ab c
A
A’
唇裂手术切口几何学原理 3 示意图
石冰 . 单侧唇裂手术设计的几何学解析 . 华西口腔医学杂志， 2000,18 （ 1 ） :3 0
上唇形态的几何学分析
梯式旋转下降的原理
健侧上唇切口的设 计，在皮肤、肌肉 和粘膜各不相同， 但是都遵循角平分 线的原则，其切口 末端都位于角平分 线上，保证皮肤、 肌肉和粘膜能获得 同样的下降幅度。
Microform unilateral cleft lip repair
Postoperative care after the cleft lip closure
• Antibiotic ointment is applied generously to all skin suture lines immediately after surgery
Artery of unilateral complete cleft lip
Skeleton defect of unilateral incomplete cleft lip
Skeleton defect of unilateral incomplete cleft lip
Skeleton defect of complete cleft lip
Prepare before operation
• General body examine • Blood examine • Liver function test • renal function test • X-ray of lung • Urine test
Timing of operation
a
b
b a a’
b’
A B
A B
Markings for an adhesion in a complete cleft lip
Lip adhesion
唇粘连术 + 唇裂修复术
5
6
3 12
78 4
Point marks for unilateral cleft lip repair
Definitive cleft lip repair
not interfere with the accomplishment of the other stated requirements
Adhesion
• Achieves a quick, easy, and effective method of applying a constricting band across the cleft
• Point1: the peak cupid’s bow on the non-cleft side
• Point2: the midline point of the arch cupid’s bow
• Point3: the proposed peak of cupid’s bow on the cleft side( distance from 1to 2)
Treatment plan of cleft lip
• Pre-surgical orthopedics • Operative repair • Correct the second deformity
Anatomy of repair
• The markings begin with a careful and accurate identification of the normal and abnormal landmarks in the cleft lip.
• Prefer operation in 3 month to 6 months is better in c hina
• Cleft lip can be repaired at any time, but the infants s hould have reached 10 weeks of age, 10 Ib in w eight, and 10 g of hemoglobin
• Point5 and point 6: the base of columella on the cleft and non-cleft sides
• Point 7 and point 8: the point at which the alar bases insert into the nostril sill
• Reproducing the normal lower border of the philtrum, Cupid’s bow contour
• Slightly eversion of the lip • A minimal scar which by its contraction will
• Some clinical prefer operating on these infants i mmediately following birth within 48 hours
• Many surgeons feel that surgery should be delayed f or a minimum of 8-10 weeks