| Objective: To evaluate the clinical safety and efficacy of autologous costal cartilage transplantation for repairing the upper lip collapsing in the second stage of cleft lip.And to explore the method of operation and the evaluation of postoperative effect.Methods: Select the 22 patients of secondary repair of upper lip collapsing with cleft lip by autologous costal cartilage transplantation in the medical center between January 2017 and August 2019.There were 17 males and 5 females with an average age of 23 years(range,18-33 years).There were 15 cases of bilateral cleft lip and 7 cases of unilateral cleft lip.All of them underwent early cleft lip repair operation at the age of 1-3 years old.After collecting and arranging the data of the patients,the subjective evaluation method and the objective evaluation method were used for statistical analysis respectively.Subjective assessment was performed by Three deputy chief surgeons or above in plastic surgery to evaluate the preoperative and postoperative collapsed appearance of the upper lip,and to evaluate the wound healing and postoperative complications of the patients.The objective evaluation method mainly evaluated two indexes: One is the scar width of the incision by follow-up at 6 months after operation,and the other is the soft tissue change of the upper lip before and after operation.In order to evaluate the soft tissue changes of the upper lip,the same surgeon took the localized lateral position photos before the operation and 3,6,12 months after the operation,by used the photo measurement and analysis method to quantitatively analyze the soft tissue profile of the upper lip.The measured indicators including the soft tissue facial angle(G-Sn-Pg'),the nasolabial angle(Cm-Sn-UL),the distance between the most salient point of the upper lip to the aesthetic plane(UL-E).The measured data was imported into SPSS22.0 statistical software for analysis.The safety and effectiveness of the surgical method were evaluated by comparing the measured data before and after operation with student's t test.Results: All 22 patients were follow-up 3-24 months,with an average of 12 months,18 patients were followed up more than 6 months and 16 cases were more than 12 months.Subjective assessment results: According to the judgement of the three plastic surgeons,the appearance of the upper lip collapsing was obviously improved after operation than before.One case had incision infection and healed after dressing change,and in the other 21 patients,the incisions healed by first intention,there were no complications such as infection or wound dehiscence or fat liquefaction,and no hypertrophic scar was found after operation.During the follow-up,all the soft tissue morphology of the upper lip remained good,and no obvious cartilage displacement,cartilage resorption,cartilage exposure and thoracic deformity were found.The cartilage was highlighted when the dynamic expression appeared in one case at 6 months after operation and had repaired after the second operation.There was no obvious cartilage highlighting during follow-up of the remaining cases.Objective assessment results: The scar widths of donor area were measured about 2mm~4mm with an average of 2.69 mm in 18 patients at 6 months after operation,and the scar width of the upper lip incision was about 1mm~2mm,with an average of 1.19 mm.There was no obvious swelling or ulceration of the skin around the incision,no obvious pruritus or pain,and the patients were able to accept it.At 3 months after operation,the measurements of UL-E were significantly decreased than those before in 22 cases,and statistically significant(P<0.001);and there was statistically significant in Cm-Sn-UL and G-Sn-Pg' between the postoperative and 3 months after operation(P<0.01).There was no statistically significant in Cm-Sn-UL and UL-E and G-Sn-Pg' between 3 months and 6 or 12 months after operation(P>0.1).The measured data was statistically significant between the preoperative and normal values in G-Sn-Pg' and Cm-Sn-UL(P<0.05),and there was no statistically significant between the normal values and data measured at 3 or 6 or 12 months after operation(P>0.1).The measured data was statistically significant between the preoperative and normal values in UL-E(P<0.001),and there was no statistically significant between the normal values and data measured at 3 or 6 or 12 months after operation(P>0.1)Conclusion: 1.The surgical method of autologous costal cartilage transplantation can effectively improve the deformity of the upper lip collapsing and make the upper lip morphology to standard after operation,the long-term follow-up results are relatively safe and stable,which is easy and worthy of clinical promotion.2.The surgical method of autologous costal cartilage transplantation is simpler than the previous clinical surgical method of repairing the upper lip collapsing,and it can adjust the radian of bridge Arch in the upper lip and the shape of the labial arch and the vermilion of the lip more conveniently during the operation,and it provides a new idea for repairing the collapsing of the upper lip.3.The surgical method of autologous costal cartilage transplantation is suitable for patients with mature maxillary and upper lip soft tissue and without obvious occlusal deformities.For the patients with severe upper lip collapsing,the effect of the operation needs to be further verified. |
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