Three-dimensional visualization of blood supply of the upper lip using micro-CT and implications for plastic surgery

A Novel Neurovascular Protection Method In Nasolabial Muscle Biomechanical Bionic Surgery For Secondary Unilateral Cleft Lip Repair: A Three-Dimensional Evaluation Of Short And Long-Term Results

BACKGROUND

Neurovascular protection within the upper lip muscles is essential in muscle tension reconstruction and functional recovery during surgery. This study aimed to investigate a novel neurovascular protection method based on the intramuscular neurovascular partitions of the upper lip applied to nasolabial muscle biomechanical bionic surgery for secondary unilateral cleft lip repair and to evaluate postoperative outcomes.

METHODS

From November 30, 2019 to October 31, 2020, 50 consecutive patients with secondary unilateral cleft lips who underwent the modified biomechanical bionic surgery were reviewed retrospectively. Three-dimensional (3D) photographs of patients were collected preoperatively, 7-day postoperatively, and during long-term follow-up (at least 6 months). The Global Aesthetic Improvement Scale was used to evaluate surgical subjective outcomes, and statistical analysis of nasolabial measurements on 3D photographs was used to evaluate objective outcomes before and after surgery.

RESULTS

The Global Aesthetic Improvement Scale showed that 94% of patients had improved upper lip morphology and 92% had improved nasal morphology 7-day postoperatively. In all, 84% maintained favorable nasolabial morphology during long-term follow-up. Statistical results showed that the postoperative alar width, philtral depth, columellar angle, and nasal base inclination angle were significantly improved compared with preoperatively ( P <0.01). The differences between the above 4 indexes were not statistically significant ( P >0.05) between 7-day postoperatively and long-term follow-up, indicating that the postoperative lasting outcomes were satisfactory.

CONCLUSIONS

The novel method of neurovascular protection in nasolabial muscle biomechanical bionic surgery can achieve a long-term improvement of labial-nasal morphology and function in patients with secondary unilateral cleft lip.

Vascular Anatomy of the Velopharyngeal Muscles and its Clinical Implications: A Fresh Cadaveric Study Based on Micro-computed Tomography

INTRODUCTION

Poor speech improvement after levator veli palatini (LVP) reconstruction may be related to intraoperative vascular injury. We aimed to examine the vascular anatomy of the velopharyngeal muscles to provide a guide for arterial protection in cleft palate repair.

MATERIALS AND METHODS

Fresh adult cadaveric heads were injected with gelatin/lead oxide. The velopharyngeal specimens were stained with iodine and scanned using micro-computed tomography. Three-dimensional reconstruction models were obtained using a computer-aided design software.

RESULTS

The ascending palatine artery (APaA), especially the posterior branch, is the main artery supplying the velopharyngeal muscles. The posterior branch of the APaA reaches the dorsal part of the musculus uvulae in the posterior one third of the soft palate (SP) and lies 1.75 mm (standard deviation, 0.06) under the nasal mucosa; the anterior branch penetrates the anterolateral side of the LVP to reach the anterior one third of the SP and lies 7.09 mm (0.03) under the oral mucosa. The posterior APaA, anterior ApaA, and ApaA trunk had mean diameters of 0.41 mm (0.04), 0.46 mm (0.06), and 0.65 mm (0.04) at 0.5 cm, 1 cm, and 1.5 cm distance from the palatal midline, respectively..

CONCLUSION

To minimize vascular injury, mobilization of muscles during intravelar veloplasty should be performed within a distance of 1 cm from the palatal midline, and dissection of the oral submucosa should be reduced in the anterior one third of the SP, while wide dissection of the nasal submucosal should be avoided in the posterior one third of the SP. This article is protected by copyright. All rights reserved.