Changes Of Lip And Nasal Symmetry After Repairing Unilateral Cleft Lip With Multi-methods

Objective: Modified Mohler’s method to repair unilateral cleft lip is widely used in clinical practice.Based on the understanding of lip-nose structure and biomechanical simulation,our department continuously improves the operation method of unilateral cleft lip.Since 2015,the operation method modified Mohler’s + Tajima incision + small triangular flap has been used to repair unilateral cleft lip.Since 2018,on the basis of the above-mentioned surgical procedures,the labionasal muscle tension band reconstruction + nasal septal cartilage reduction has been added.Based on the analysis of objective data,this study explored the effects and changes of the labial-nasal symmetry of the different surgical methods in the above,and tried to find a unilateral cleft lip repair that can maintain labial-nasal symmetry for a long time after surgery.Method: The first part(Chapter 2)collects 81 cases of unilateral cleft lip repair who underwent modified Mohler’s method + Tajima incision + small triangular flap in our department from January 2015 to December 2017.In the second part(Chapter 3),52 cases of unilateral cleft lip cases from January 2018 to December 2020 were collected in our department who received modified Mohler’s method + labionasal muscle tension band reconstruction + nasal septal cartilage reduction + Tajima incision + small triangular flap.The picture measurement software was used to measure the two parts of patients before surgery and 1-14 days after surgery,1month to 3 months after surgery,3 months to 6 months after surgery,6 months to 1 year after surgery,and more than 1 year after surgery.12 linear distances(bilateral red lip thickness,bilateral nasal mouth angle distance,bilateral lip peak mouth angle distance,bilateral nasal lip peak distance,bilateral nose width,bilateral nostril height)and one angle(the deflection angle of the nasal columella)in 6 periods above are collected.Symmetry rate(SR)of each index was used as the final evaluation index.The paired t-test was used to evaluate whether the SRs of pre operational stage and post operational stages were different.Through the broken line chart of the mean value of SRs,the changes of labial-nasal symmetry at various periods after different surgical procedures was analyzed.Results: The first part: There were statistical differences between the postoperative SR and each preoperative SR.On the line graph,the mean SR values of red lip thickness,nasal alar mouth angle distance,lip peak mouth angle distance,and nasolabial lip peak distance were the lowest in the 1-14 days after the operation.A slight increase in the mean SR was observed in the middle and long term after the operation.The increase in the period 1-3months after the operation is the most obvious.Over 1 year after operation,the mean SR dropped again,but it was still slightly higher than the 1-14 days after operation.The mean value of SR for the width of the nose and the height of the nostril reached the lowest in the period of 1-3 months after the operation,and the mean value of the SR increased slightly in the middle and long term after the operation.The mean SR of the nasal columella deflection angle at each postoperative period is5-10,which is lower than that before operation.And there is a slight fluctuation in the middle and long term after the operation.The second part: Except for the deflection angle of the nasal columella,the immediate postoperative improvement effect of the symmetry of the nasolabial is roughly the same as that of the first part.Among them,the mean SR values of the lip-peak mouth angle distance,the nasal alar mouth angle distance,and the nasal alar width decreased significantly after the operation,and remained stable and continuously low during the observation period.The SR value of nostril height decreased most significantly after surgery,and continued to decrease during 1-14 days,1-3 months,and 3-6 months after surgery.The lowest value appeared in 3-6 months after surgery,and at 6 months after surgery.There was a slight rebound in the 1-year period.The mean SR of the nasal columella deflection angle in each postoperative period was 0-5,which was significantly lower than that before the operation,and remained stable and continuously low during the observation period.Conclusion: The modified Mohler’s method + Tajima incision + small triangular flap to repair unilateral cleft lip has achieved satisfactory immediate postoperative results in the repair of unilateral cleft lip.However,this method mainly relies on the accumulation and traction of muscle tissue to close the gap,and does not solve the problem of structural tension imbalance.Therefore,the lip-nasal symmetry has been reduced in the mid-and long-term.From 2018 to2020,our department has added lip nasal muscle tension band reconstruction and nasal septal cartilage reduction to the above surgical methods,which can not only achieve a symmetrical and harmonious lip-nose shape after surgery,but also maintain high lip-nose symmetry for a long time.