Eighty Cases Report On Reparation Of The One-stage Unilateral Cleft Lip Through The Degloving Anatomical Technique On The Orbicularis Oris

ObjectiveTo illustrate the efficiency of degloving anatomical technique on the orbicularis oris in the one-stage reparation operation of the unilateral cleft lip and investigate the incidence of postoperative complications and patients’satisfaction. To explore the significance of this technique on the one-stage unilateral cleft lip.MethodsDegloving anatomical technique on the orbicularis were used to treat theⅠ°、Ⅱ°、 Ⅲ°unilateral cleft lip patients. There were20patient with Ⅰ°cleft lips,30patients with Ⅱ°cleft lip and30patients with Ⅲ°cleft lip. Preoperative and postoperative photographs were taken to measure the ipsilateral upper white lip height, upper lip height, width of mouth, nose mouth ipsilateral distance, the bottom width of the nose, nostrils transverse width and height columell. The operations were taken by using degloving anatomical technique based on the improved Millard ways and combined with the ways of Prof. Shi Bing. Duration of the operation and the level of bleeding were observed. Postoperative measurements in children including patients’upper lip and full face, including the degree of coordination on nose, low lip and both sides of the cheek, length and width of white-lip and red-lip, uniformity of vermilion border, the lip bow dimensional sense, position of philtrum, nasal columella,the tip of the nose and nasal long axis, and both sides of the nosewings radian were performed. In children’s resting states, the measured preoperative and postoperative ipsilateral upper white lip height, upper lip height, width of mouth, nose mouth ipsilateral distance, the bottom width of the nose, nostrils transverse width and height columella indicators and compared with the contralateral understand its symmetry. The incidence of postoperative complications was also observed. After one month, two months, three months, six months, one year, the associated data, questionaire and survey to understand family satisfaction were taken respectively.ResultsThe average operation time was two hours. The average bleeding volume was15ml. Among the80cases, there were wound swelling in3patients with Ⅲ°cleft lip after operation.The wound was healed well without wound dehiscence after changing dressiong. There were more obvious wound scar in two cases. The complication rate was2.5%.We observed that there were perfect coordination on patients’nose, lower lip and both sides of the cheek. There were suitable length and width on white-lip and red-lip. Vermilion border was nature. The dimensional sense of lip bow was good. Th position of philtrum was in center. But, philtrum column of malformed side was not obvious. Bilateral lip peak were obvious and more symmetric. Anteflexion of red-lip was vivid. Nasal columella, the tip of the nose and nasal long axis were all came back the middle line. The both sides of the nosewings radian was consistency. The nasal base was in a horizontal line. Both sides of the nostrils size was approximate symmetry and patient had an unobstructed breathing. But there were not significantly different in results of white-lip height, oral fissure width, the malformed nosewing-cheilion distance, the width of the nasal floor, the width of the nostrils transverse diameter and nasal columella height. We found that the red upper-lip heights ofⅠ°cleft lip patients who were operated by this way were distinct increase than heights of preoperation(p<0.05)。But there were no significantly difference in results of white-lip height, oral fissure width, the malformed nosewing-cheilion distance, the width of the nasal floor, the width of the nostrils transverse diameter and nasal columella height. For Ⅱ°cleft lip patients, there were significantly different in results of upper white-lip, up red-lip, nasal columella, the width of the nasal floor and the width of the nostrils transverse diameter during the operations(p<0.05).But there were no significantly difference in results of oral fissure width and the malformed nosewing-cheilion distance(p>0.05).For Ⅲ°cleft lip patients, there were very significantly different in results of every aspects(p<0.05). For Ⅱ°cleft lip patients,there were significantly different in results of upper white-lip, up red-lip, nasal columella, the width of the nasal floor and the width of the nostrils transverse diameter during the operations(p<0.05).But there were no significantly different results of oral fissure width and the malformed nosewing-cheilion distance(p>0.05). Families of children with postoperative satisfaction survey found that two cases with obvious scars were not very satisfactory four cases due to curvature and plumpness vermilion border was not satisfied, two cases of nasal deformity due to obvious improvement was not satisfied, and the remaining66cases expressed great satisfaction, six cases expressed satisfaction. No situation was very unsatisfactory.Conclusions1) The degloving anatomical technique on the orbicularis oris is efficient in treating Ⅲ°one-stage cleft lip.2) There is less complication in local wound and the shape is satisfactory.3) The degloving anatomical technique on the orbicularis oris improves the structure of nose and upper lip morbid and plays a good role in sequential therapy.4) The technique with less operation time and bleeding is simple to master and worthy to promote.