| Objective: In the area of the cleft lip repair,except Millard's technique,Tennison–Randall's technique is also widely applied in clinic.Based on the principle of geometry and combining the reconstruction of orbicularis and the anatomical structure of vermilion,we made some modifications on the classic Tennison-Randall's technique and evaluated the postoperative outcomes with photogrammetry objectively.And we compared it with classical Tennison–Randall's technique and modified Mohler technique(a kind of modified Millard technique)respectively,exploring the objective effect and possible advantages of modified Tennison-Randall technique and trying to find a more suitable method for beginners to repair unilateral cleft lip.Clinical Materials and Methods: This is a retrospective study.Part ?: The unilateral cleft lip patients repaired with classic or modified Tennison-Randall's techniques from 2009 to 2014 in our department were choose as the research objects.Among them,110 patients who underwent classical(n=54)and modified Tennison-Randall's techniques(n=56)met the inclusion criteria.Eight distances at preoperatively and 1 week,3 months,6 months,1 year or more postoperatively were measured respectively with photogrammetry.The symmetry ratio(SR)was used as the final evaluation index.The SRs of two techniques at the same time and the SRs of the same technique at different time points were compared,and statistical analysis was performed to objectively evaluate the surgical outcomes of classic and modified Tennison-Randall's techniques.Part ?: The patients of this group were from January 2012 to June 2016 in our department who accepted unilateral cleft lip repair.Among them,201 patients who underwent modified Mohler(n=122)and modified Tennison-Randall's techniques(n=79)were in accordance with the inclusion criteria.The postoperative outcomes were assessed by photogrammetry.The frontal views of patients at preoperatively and 1week(1w),3 months(3m),6 months(6m),1 year or more(1y)postoperatively were obtained.Five linear distances and three vertical distances were measured.The symmetry ratio(SR)of each index was calculated and as the evaluation index for surgical outcomes.The SRs of the two techniques at the same time point and the SRs of the same technique at different time points were compared,and statistical analysis was performed to objectively evaluate the surgical outcomes of modified Mohler and modified Tennison-Randall's techniques.Results: Part ?: The comparisons between two techniques at the same time point: Preoperatively,all distances on the affected side were shorter,but the SRs had no statistical difference(P>0.05);Postoperatively,the SRs of vertical sbal-cphi,sbal-cphi,vertical sn-cphi at all intervals and the SRs of sn-cphi except 1y respectively presented significant differences(P<0.05),while the others had no statistical significances(P>0.05).The comparisons between different time points in the same technique: No matter which technique was adopted,the comparisons of SRs of all the measurements had statistical significances between pre-operation and any other time points after surgery(P<0.05).At the same time,the symmetry ratios in both groups were the worst at 3m,then gradually improved;While,when compared between two intervals after surgery,only partial SRs had statistical significances(P<0.05).However,all the patients with classic Tennison-Randall's technique were performed by senior doctors,while,even if some cases were performed by junior or young doctors,the SRs of the patients under the modified method were closer to 1.Part ?: The comparisons between two techniques at the same time point: Preoperatively,except sn-cphi and vertical sn-cphi,the SRs of the other measurements had no statistical differences(P>0.05);1w postoperatively,all SRs had no statistical differences(P>0.05);3m postoperatively and beyond,all the SRs of all indexes except for sbal-ch and vertical sbal-ch had statistical differences(P>0.05).The comparisons between different time points in the same technique: The variation tendency of postoperative outcomes of two techniques were basically the same.That is,the symmetry ratio was the worst at 3m and tended to be stable at 6m.In the patients who underwent modified Mohler technique,compared between pre-operation and any interval after surgery,except vertical sbal-cphi(pre vs 6m)and sbal-cphi(pre vs 3m),the SRs of other indexes were statistically significant(P<0.05);while,compared between any two intervals after surgery,except vertical sn-cphi,sn-cphi,vertical sbal-cphi and vh,the SRs of the rest measurements had statistical differences only between partial intervals(P < 0.05).In the patients with modified Tennison-Randall's technique,compared between pre-operation and any interval after surgery,except vertical sbal-cphi(pre vs 3m and pre vs 6m),the SRs of other indexes had statistical differences(P < 0.05);while,compared between any two intervals after surgery,only vh had statistical differences between all intervals(P<0.05),and the SRs of the remaining indexes had significant differences only in partial intervals(P<0.05).Conclusion: Compared with classical Tennison-Randall's technique,modified Tennison-Randall's technique got better outcomes.It is accurately marking,less flexible and more suitable for young doctors.Because of the operative design and postoperative scar contraction,the modified Mohler presented larger fluctuation range compared with the modified Tennison-Randall's technique,but its applicable scope is more extensive,especially for unilateral cleft patients with bigger height difference of bilateral philtral ridges.And the preoperative height difference of bilateral philtral crests decides the option of surgical technique. |
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