The Correction Of The Secondary Lip-nasal Deformities Of Cleft Lip

cleft lip is a common congenital deformity . Essentially all the patients are operated on within the first year of life. The secondary Lip-nasal deformities present inevitably in the vast majority of cleft lip patients,due to the inherent deficiency,the option of the time and method of the first correction,and the surgery skill . The typical secondary deformities consist of notch vermilion,short lip,distorted vermilion and unsatisfactory scarring,asymmetrical nostrils,the deformity of the nasal lip,columella shortened and deciated ,the nose alar dome sunk on the cleft side,the lateral crus displaced laterally,and so on . Secondary cleft lip deformities of the diversity and flexibility of operation to the clinical variability of the treatment of a doctor brought many problems . The manifestation of the secondary deformities is so varied that the corresponding repairing is complex. This study was designed by the parameter evaluation of deformity before the secondly plasty, to better understand the extent and patterns of deformity, correction function from anatomy and physiology of secondary cleft lip nasal deformity, and thus to find effective methods of clinical surgery .Objective:With the cleft lip repair surgery technology continues to improve,In recent years, the effect of surgery can receive basically anatomic reduction, But for various reasons, such as growth and development of the uninvolved asymmetric,With the increasing age of the patient, nose and lips, there have been a secondary deformity, affect the appearance of patients seriously, affecting the confidence of patients, affecting their work and life. The authors discussed the individual secondary deformities of cleft lip repair a clinical feasibility, assess the reliability and effectiveness of surgical methods.Methods:1,Lip nasal deformities preoperatively to assess the situation carefully ,and summarized for each individual patient ,then design of targeted individual restoration program preoperative.2,on the lip and nasal deformity preoperatively to assess the situation, according to the different circumstances of each patient, to design individualized programs targeted.3,the most common deformities are upper lip skin scar,philtrim deficiency,Cupid's Bow Deformity,vermilion notching,labial tubercle deficiency,the nasal columella deviate to the non-cleft side,the lateral crus of the lower lateral cartilage on the cleft side is slumped and displaced,the alar base was displaced posteriorly and inferiorly,asymmetry of two nostrils,alveolar cleft,and the corresponding modus operandi is excision of the superficial scar,reconstructing the philtrim with the left scar flap,repositing the orbicularis oris muscle,reconstructing the nasal base and augmenting the vermilion notching with local rearrangement of tissue,skin excision to reconstruct the Cupid's bow,alar cartilage sling and alar cartilage trimming to resolve the asymmetry of two nostrils and nasal ala's slump,spongy bone transplanting from the ilium to fill the alveolar cleft,et al.Results:1,26 patients were in clinical preoperative assessment of lip and nasal deformities ,such as The assessment of White lips, red lips, scar appearance, labial arch shape, lip height, nostril symmetry, nose dome symmetry, alar base symmetry of foot. In Lip parameters,the Red lips, scar appearance, labial arch form is poor,in assessment of nasal parameters,Nostril asymmetry,Wing bending hole and Alar footing's Asymmetry rate is 65.38%,88.46%and57.69%, This may be more conservative surgery, and less emphasis on the lip repair, not for repair of nasal deformities.Most patients after surgerly have different degrees of nasolabial deformities, the second cleft lip surgery is particularly necessary.2,Treatment of 26 patients were followed up to 26 cases (20 patients to the hospital referral, and other are for the telephone follow-up), self-satisfaction of 24 patients, no change in 1 case, unsatisfactory in 1 case, 92.3% satisfaction rate, not satisfied conscious patients with one case of lip incision scar is still obvious. Doctors to have the photos satisfaction survey data, 26 cases, 23 cases satisfied, satisfaction was 88.5%.Conclusions:Preoperative nasolabial deformities in patients with the objective of the comprehensive and careful evaluation, the design of targeted individual operation mode, corresponding fine anatomy of orbicularis muscle separation, precision reset, exactly on the joint, with particular emphasis orbicularis muscle bundles ipsilateral nasal ala Anatomic reduction of cartilage, secondary treatment of cleft lip nasal deformity where the problem lies. Lip nose flap to protect the blood supply, promote wound healing, prevent infection or other wound erosion. Some patients were followed up for six months, the recent good results.