Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Xiaoqian ^1,2 ,  YOU Xiaobo ^1,2 , CAI Zhen ² , LIU Quan ² , DU Liping ² , CHEN Zaihong ² , CUI Wei ² , SHENG Yang ²

1. Graduate School of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Plastic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

YOU Xiaobo, Email: yxb_plastic@163.com

Keywords：

Autologous costal cartilage transplantation; the secondary repair of cleft lip; upper lip depression

DOI：

10.7507/1002-1892.201906070

Video：

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Objective To discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip.Methods The clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg’), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg’), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP).Results One case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg’, UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg’ was significantly decreased when compared with preoperative ones (P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation (t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found.Conclusion Autologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.

Citation： ZHANG Xiaoqian, YOU Xiaobo, CAI Zhen, LIU Quan, DU Liping, CHEN Zaihong, CUI Wei, SHENG Yang. Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 200-205. doi: 10.7507/1002-1892.201906070 Copy

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2.	尹寧北. 唇裂繼發鼻畸形的肌肉生物力學理解與生物力學仿生矯正. 中國美容整形外科雜志, 2018, 29(4): 193-196.
3.	Naidoo S, Bütow KW. Philtrum reconstruction in unilateral cleft lip repair. Int J Oral Maxillofac Surg, 2019, 48(6): 716-719.
4.	孫晶. 單側唇裂修復術后繼發紅唇畸形的臨床分析及Ⅱ期手術修復效果分析. 中外醫療, 2018, 37(8): 57-59.
5.	張磊, 陳仁吉. 先天性唇裂修復術后繼發中央組織缺損 120 例手術治療體會. 山東醫藥, 2010, 50(47): 104-105.
6.	林廣民, 游彩蓮, 曹寧, 等. 應用上唇人中區皮瓣聯合下唇 Abbe 瓣修復雙側唇裂繼發鼻唇畸形. 中國醫療美容, 2019, 9(4): 18-20.
7.	趙偉萍, 盧小生, 劉媛媛, 等. 口輪匝肌條形旋轉肌瓣修復單側唇裂繼發鼻底塌陷畸形效果觀察. 山東醫藥, 2018, 58(10): 83-85.
8.	向宏偉, 鄭海梅, 鄭海山, 等. 膨體聯合自體肋軟骨治療短鼻塌鼻鼻基底凹陷癥的臨床應用研究. 中國醫療美容, 2018, 8(10): 33-35.
9.	蔣治遠, 游曉波, 蔡震, 等. 自體肋軟骨移植技術修復 Binder 綜合征的療效評價. 中國修復重建外科雜志, 2018, 32(8): 1056-1060.
10.	Carruthers A, Carruthers J, Hardas B, et al. A validated lip fullness grading scale. Dermatol Surg, 2008, 34 Suppl 2: S161-S166.
11.	Kane MA, Lorenc ZP, Lin X, et al. Validation of a lip fullness scale for assessment of lip augmentation. Plast Reconstr Surg, 2012, 129(5): 822e-828e.
12.	謝永建, 段玉貴, 王大為, 等. 上頜前牽引對單側完全性唇腭裂術后患者軟組織側貌的影響. 華西口腔醫學雜志, 2001, 19(4): 237-239.
13.	劉慶成, 王敏嬌, 司家文, 等. 前段截骨牽引治療唇腭裂繼發上頜骨發育不足. 口腔頜面外科雜志, 2017, 27(3): 179-184.
14.	Buckingham ED, Bader B, Smith SP. Autologous fat and fillers in periocular rejuvenation. Facial Plast Surg Clin North Am, 2010, 18(3): 385-398.
15.	Kar M, Muluk NB, Bafaqeeh SA, et al. Is it possible to define the ideal lips? Acta Otorhinolaryngol Ital, 2018, 38(1): 67-72.
16.	Wei J, Luo J, Herrler T, et al. A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants. J Plast Reconstr Aesthet Surg, 2017, 70(9): 1292-1297.
17.	Raposo-Amaral CE, Denadai R, Alonso N. Three-dimensional upper lip and nostril sill changes after cleft alveolus reconstruction using autologous bone grafting versus recombinant human bone morphogenetic protein-2. J Craniofac Surg, 2016, 27(4): 913-918.
18.	張俊慧, 熊炳鈞, 邱娟娟, 等. 脂肪干細胞及血管內皮細胞提高游離脂肪移植成活的實驗研究. 中國修復重建外科雜志, 2018, 32(8): 1074-1080.
19.	張蘭芳. 眶下神經阻滯麻醉聯合自體脂肪移植治療面中部凹陷的療效觀察. 實用臨床醫藥雜志, 2015, 19(21): 127-128.
20.	葉犀皓, 梁杰. 牙槽突裂植骨治療的研究進展. 海南醫學, 2019, 30(4): 534-537.
21.	范曉楓, 楊壯群, 文抑西. 頜面部軟組織測量技術的發展. 中國美容醫學, 2004, 13(4): 500-502.

1. 王煒. 整形外科學. 杭州: 浙江科學技術出版社, 1999: 657-678.
2. 尹寧北. 唇裂繼發鼻畸形的肌肉生物力學理解與生物力學仿生矯正. 中國美容整形外科雜志, 2018, 29(4): 193-196.
3. Naidoo S, Bütow KW. Philtrum reconstruction in unilateral cleft lip repair. Int J Oral Maxillofac Surg, 2019, 48(6): 716-719.
4. 孫晶. 單側唇裂修復術后繼發紅唇畸形的臨床分析及Ⅱ期手術修復效果分析. 中外醫療, 2018, 37(8): 57-59.
5. 張磊, 陳仁吉. 先天性唇裂修復術后繼發中央組織缺損 120 例手術治療體會. 山東醫藥, 2010, 50(47): 104-105.
6. 林廣民, 游彩蓮, 曹寧, 等. 應用上唇人中區皮瓣聯合下唇 Abbe 瓣修復雙側唇裂繼發鼻唇畸形. 中國醫療美容, 2019, 9(4): 18-20.
7. 趙偉萍, 盧小生, 劉媛媛, 等. 口輪匝肌條形旋轉肌瓣修復單側唇裂繼發鼻底塌陷畸形效果觀察. 山東醫藥, 2018, 58(10): 83-85.
8. 向宏偉, 鄭海梅, 鄭海山, 等. 膨體聯合自體肋軟骨治療短鼻塌鼻鼻基底凹陷癥的臨床應用研究. 中國醫療美容, 2018, 8(10): 33-35.
9. 蔣治遠, 游曉波, 蔡震, 等. 自體肋軟骨移植技術修復 Binder 綜合征的療效評價. 中國修復重建外科雜志, 2018, 32(8): 1056-1060.
10. Carruthers A, Carruthers J, Hardas B, et al. A validated lip fullness grading scale. Dermatol Surg, 2008, 34 Suppl 2: S161-S166.
11. Kane MA, Lorenc ZP, Lin X, et al. Validation of a lip fullness scale for assessment of lip augmentation. Plast Reconstr Surg, 2012, 129(5): 822e-828e.
12. 謝永建, 段玉貴, 王大為, 等. 上頜前牽引對單側完全性唇腭裂術后患者軟組織側貌的影響. 華西口腔醫學雜志, 2001, 19(4): 237-239.
13. 劉慶成, 王敏嬌, 司家文, 等. 前段截骨牽引治療唇腭裂繼發上頜骨發育不足. 口腔頜面外科雜志, 2017, 27(3): 179-184.
14. Buckingham ED, Bader B, Smith SP. Autologous fat and fillers in periocular rejuvenation. Facial Plast Surg Clin North Am, 2010, 18(3): 385-398.
15. Kar M, Muluk NB, Bafaqeeh SA, et al. Is it possible to define the ideal lips? Acta Otorhinolaryngol Ital, 2018, 38(1): 67-72.
16. Wei J, Luo J, Herrler T, et al. A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants. J Plast Reconstr Aesthet Surg, 2017, 70(9): 1292-1297.
17. Raposo-Amaral CE, Denadai R, Alonso N. Three-dimensional upper lip and nostril sill changes after cleft alveolus reconstruction using autologous bone grafting versus recombinant human bone morphogenetic protein-2. J Craniofac Surg, 2016, 27(4): 913-918.
18. 張俊慧, 熊炳鈞, 邱娟娟, 等. 脂肪干細胞及血管內皮細胞提高游離脂肪移植成活的實驗研究. 中國修復重建外科雜志, 2018, 32(8): 1074-1080.
19. 張蘭芳. 眶下神經阻滯麻醉聯合自體脂肪移植治療面中部凹陷的療效觀察. 實用臨床醫藥雜志, 2015, 19(21): 127-128.
20. 葉犀皓, 梁杰. 牙槽突裂植骨治療的研究進展. 海南醫學, 2019, 30(4): 534-537.
21. 范曉楓, 楊壯群, 文抑西. 頜面部軟組織測量技術的發展. 中國美容醫學, 2004, 13(4): 500-502.

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Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip

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