| Objective: To investigate the value of the new method with commom pedicle lip mucosa flaps for reconstruction of vermilion tubercleMethods:On both sides of the central defect of vermilion tubercle,design reverse triangular flaps below the junction between vermilion and mucosal.These two flaps have the common pedicle of vermilion depression site.Incisions of “?” shape were designed below the defect area and the flaps include mucosa and submucous tissue.This mucosa flaps were raised and orbicularis oris muscles under the flaps were free moderately.Bilateral orbicularis oris muscles were sutured under the common pedicle of the two mucosa flaps.Then the bilateral mucosa flaps were rotated down 90o and inserted into the “?” shape incisions to increase the tissue volume of the middle upper lip and deepen the labiogingival sulcus.The common pedicle of the bilateral mucosa flaps was formed to the vermilion tubercle and then the incisions were sutured layer by layer.Postoperative from upper lip deformities "whistle" improvement,tubercle shape,tubercle organization increase,to evaluate the results.Using quantitative score method to evaluate the efficacy of the procedure.Measurements were used to calculate lip fullness.According to patients to assess effect of self-satisfaction.(1)"whistle" deformity to improve: "whistle deformity disappeared three points," smaller "whistle" deformity meter 2 points,no obvious improvement 1 points;(2)tubercle shape: obvious tubercle for 3points,with tubercle but not obvious for 2 points,1 points no improvement;Lateral measurements of the upper lip were performed.(3)the increased amount of tubercle organization,upper lip most take measurements before and after surgery were to Burstone standard plane(under the nose to pogonion attachment formed by the standard flat)distance: > 3 mm 3 points,1 mm ~ 2 mm 3 points,< 1 mm(4)patient satisfaction: very pleased to 3 points,satisfaction to 2 points,not satisfied for 1 minute.Higher scores on behalf of the operation effect,the better,with a score of 10 ~ 12 divided into improved significantly,6 ~ 9 is divided into improved,and 5 points,the following is not satisfied.For this lateral projection measurement,the right-angled distance from the N-P line(nasospinale to pogonion is the Burston)to the anterior lip projection point was used.Augmentation percentage was documented using follow-up measurements compared with preoperative measurements.An unpaired t test was used to determine significance between preoperative and follow-up measurements.Results between preoperative and follow-up lateral projection measurements are given as mean± SD.A value of P < 0.05 was considered statistically significant.Results: The technique has been performed on 37 patients including 18 cases of upper-lip vermilion defect after repair of bilateral cleft lip,14 cases of upper-lip vermilion defect after repair of unilateral cleft lip.4cases of upper-lip vermilion defect after tumour operation.1case of upper-lip vermilion defect after traumtic.All the lip mucosa flaps survived completely without any complications.All patirnts,29 cases had excellent effects(scores between 11 to 12),7cases had good effects(scores between 9 to 10),1cases hadaverage effects(scores between 46 to 9).Lateral projection measurements of the reconstructive vermilion tubercle showed a mean increase of151% ± 42% after the operation(P<0.05).There were minimal perioperative complications.The color and texture matched well with the surrounding tissue.The vermilion,tubercle and shape of the lips were satisfactory after all cases were repaired and all incision scars were concealed.Conclusions: Using commom lip mucosa flaps transfer to repair vermilion tubercle with the same kind tissue can obtain satisfactory appearance.The lip mucosa flaps are ideal for repairing of the lip vermilion defect and recovering of the profile of labial arch and vermilion tubercle.It can be used widely in any cases with the central defect of vermilion tubercle. |
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