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Surgical Atlas of pediatric otolaryngology - part 10

Các khâu "chìa khóa" đầu tiên (3-0 hoặc Vicryl 4-0) được đặt sâu sắc từ việc cắt giảm trở lại để cạnh cấp trên của nắp tiến bộ tại hoặc bên đến 9. Điều này tiến bộ nắp môi bên và làm giảm căng thẳng trên các đường khâu ORIS orbicularis (hình 33-1C). Nó cũng sản xuất lồi bình thường hơn với môi. | 768 Surgical Atlas of Pediatric Otolaryngology Suturing The first key suture 3-0 or 4-0 Vicryl is placed deeply from the back-cut to the superior edge of the advancement flap at or lateral to 9. This advances the lateral lip flap and reduces tension on the orbicularis oris sutures Figure 33 1 C . It also produces more normal convexity to the lip. The orbicularis oris muscles are approximated with interrupted 4-0 or 5-0 Vicryl Figure 33-1D . Assessment of lip length and symmetry is made after each suture is placed to ensure that the lip has not been shortened. This closure includes the muscle fibers present in the vermilion edge to avoid notching at the vermilion border the whistle-tip deformity . The position of the alar base is determined and it is sutured into position Figure 33-1D . The tip of the alar base flap is sutured to the anterior nasal spine with 4-0 or 5-0 Vicryl to create symmetry with the noncleft side. There should be minimal if any trimming of the alar base to avoid narrowing or stenosis of the nostril a secondary deformity that is very difficult to correct later . If needed a small crescent of cheek skin may be excised to prevent excessive narrowing of the nostril. The skin edges are trimmed if necessary and slightly undermined to allow the edges to be everted. The c flap is advanced upon itself to lengthen the columella and or is utilized for nasal sill reconstruction. The white roll flap is incised if needed. If additional rotation is required to horizontally align the Cupid s bow a small incision at the VCJ is made at 3. If the position of Cupid s bow is adequate a small triangular skin excision at 3 is made the same size of the white roll flap. Subcutaneous 6-0 chromic or Vicryl secures the flap into place. Using interrupted 7-0 nylon sutures the skin edges are approximated and everted Figure 33-1 . The vermilion-cutaneous junction is carefully approximated with 7-0 nylon at the vermilion border. The mucosa is approximated with 5-0 or 6-0 .