B型超声波观测口轮匝肌及其在单侧唇裂术后评估中的应用
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摘要
目的：了解B型超声波观测口轮匝肌的可行性,并探讨其在单侧唇裂术后疗效评估中的应用价值。
方法：应用B型超声波对168名19-25岁正常人及36名同年龄段单侧唇裂术后患者的上唇口轮匝肌进行观测,在不同生理状态下记录口轮匝肌超声声像图并定点测量口轮匝肌浅、深层厚度,记录其数值,所得数据进行统计学分析。此外,在B超下测量唇裂术后患者口轮匝肌瘢痕的宽度、厚度；并测量6项唇部术后外观评价指标；分析口轮匝肌修复重建效果、瘢痕愈合情况与外观评价的关系。
结果：1、正常人与唇裂术后患者上唇B超声像图表现：正常人上唇组织的超声声像图为一多层次结构：由浅到深是表现为连续致密高回声线的皮肤、稍低回声的口轮匝肌浅层、条索状低回声的口轮匝肌深层,稍低回声的粘膜下层和稍强回声的粘膜层；唇裂术后青年上唇组织健侧尚可清晰分出各层组织,在患侧相当于人中嵴处,可见到口轮匝肌浅、深层连续性不同程度中断,被高回声的瘢痕组织取代,各层组织分层不清。
2、在不同生理状态下(自然闭嘴和撅嘴),男女口轮匝肌厚度无明显差别。口轮匝肌浅层在人中凹处最薄,两侧人中嵴处最厚,呈一个“中间低,两边高”的形态；口轮匝肌深层为一均厚的带状肌肉。在撅嘴状态下,口轮匝肌浅层肌肉增厚,深层无明显变化。
3、单侧唇裂术后患者上唇口轮匝肌浅层超声测值,越靠近患侧瘢痕处的测量值越小,差异具有统计学意义(P<0.05)。
4、唇裂术后患者6项外观评价指标与口轮匝肌瘢痕宽度相关性有统计学意义(P<0.05)；口轮匝肌重建修复效果好,瘢痕宽度小的,外观评价优良；口轮匝肌重建修复效果差,瘢痕宽度宽的,外观评价较差。
结论：应用B型超声检查上唇口轮匝肌切实可行,可以获得与实体解剖层次相吻合的超声声像图；唇裂修复术后的口轮匝肌浅层肌肉厚度与正常人群的差异考虑与手术创伤及先天发育不足有关；利用B型超声波观察单侧唇裂术后口轮匝肌修复重建效果和检测瘢痕宽度进行唇裂术后效果评价,与临床观察结果相符,有一定的临床应用价值。
Objection:To realize the feasibility of which the observation of the orbicularis oris with the high frequency ultrasound and explore it's application in the postoperative evaluation of unilateral harelip
Methods:Using the high frequency ultrasound to observe the upper lip orbicularis oris of168normally adults and36adult postoperative patients of unilateral harelip. Scan the upper lip orbicularis oris and observe the shape and structure of the orbicularis oris in ultrasonogram. According to the gross anatomy and microscopic anatomy of human specimens, measure the orbicularis oris'thickness; and then measure the36adult postoperative patients'cicatrix width and thickness of orbicularis oris, then analyze the relation with6indexs of upper lip deformity. Analyze the the relation between plerosis effect of orbicularis oris and hand evaluation of postoperative patients.
Results:The upper lip organizations are different between the normal youth and unilateral cleft lip postoperative youth in ultrasonogram: the upper lip organizations are divided into five layers from shallow to deep in the normal youth. The orbicularis oris of postoperative patients is interrupt and malposition. The thickness of the men and women's orbicularis oris are the same; the shallow layer shows a "among low, both sides high" form and it will become thickened in pouted state. The postoperative patients'shallow layer are thinner than the normal youth.6indexs of upper lip deformity and cicatrix width are statistically significant correlation; It is associated with better orbicularis oris plerosis, smaller cicatrix width and good hand evaluation of postoperative patients.
Conclusion:Using the Ultrasound technology to observe the orbicularis oris can obtain a clear Dimensional Ultrasonographic of the anatomical structure, it not only can be used to observe the plerosis effect of orbicularis oris, but also used to evaluate the operation effect. The orbicularis oris with cicatrix will impact the growth of the shallow layer but not the deep layer of the orbicularis oris.
方法：应用B型超声波对168名19-25岁正常人及36名同年龄段单侧唇裂术后患者的上唇口轮匝肌进行观测,在不同生理状态下记录口轮匝肌超声声像图并定点测量口轮匝肌浅、深层厚度,记录其数值,所得数据进行统计学分析。此外,在B超下测量唇裂术后患者口轮匝肌瘢痕的宽度、厚度；并测量6项唇部术后外观评价指标；分析口轮匝肌修复重建效果、瘢痕愈合情况与外观评价的关系。
结果：1、正常人与唇裂术后患者上唇B超声像图表现：正常人上唇组织的超声声像图为一多层次结构：由浅到深是表现为连续致密高回声线的皮肤、稍低回声的口轮匝肌浅层、条索状低回声的口轮匝肌深层,稍低回声的粘膜下层和稍强回声的粘膜层；唇裂术后青年上唇组织健侧尚可清晰分出各层组织,在患侧相当于人中嵴处,可见到口轮匝肌浅、深层连续性不同程度中断,被高回声的瘢痕组织取代,各层组织分层不清。
2、在不同生理状态下(自然闭嘴和撅嘴),男女口轮匝肌厚度无明显差别。口轮匝肌浅层在人中凹处最薄,两侧人中嵴处最厚,呈一个“中间低,两边高”的形态；口轮匝肌深层为一均厚的带状肌肉。在撅嘴状态下,口轮匝肌浅层肌肉增厚,深层无明显变化。
3、单侧唇裂术后患者上唇口轮匝肌浅层超声测值,越靠近患侧瘢痕处的测量值越小,差异具有统计学意义(P<0.05)。
4、唇裂术后患者6项外观评价指标与口轮匝肌瘢痕宽度相关性有统计学意义(P<0.05)；口轮匝肌重建修复效果好,瘢痕宽度小的,外观评价优良；口轮匝肌重建修复效果差,瘢痕宽度宽的,外观评价较差。
结论：应用B型超声检查上唇口轮匝肌切实可行,可以获得与实体解剖层次相吻合的超声声像图；唇裂修复术后的口轮匝肌浅层肌肉厚度与正常人群的差异考虑与手术创伤及先天发育不足有关；利用B型超声波观察单侧唇裂术后口轮匝肌修复重建效果和检测瘢痕宽度进行唇裂术后效果评价,与临床观察结果相符,有一定的临床应用价值。
Objection:To realize the feasibility of which the observation of the orbicularis oris with the high frequency ultrasound and explore it's application in the postoperative evaluation of unilateral harelip
Methods:Using the high frequency ultrasound to observe the upper lip orbicularis oris of168normally adults and36adult postoperative patients of unilateral harelip. Scan the upper lip orbicularis oris and observe the shape and structure of the orbicularis oris in ultrasonogram. According to the gross anatomy and microscopic anatomy of human specimens, measure the orbicularis oris'thickness; and then measure the36adult postoperative patients'cicatrix width and thickness of orbicularis oris, then analyze the relation with6indexs of upper lip deformity. Analyze the the relation between plerosis effect of orbicularis oris and hand evaluation of postoperative patients.
Results:The upper lip organizations are different between the normal youth and unilateral cleft lip postoperative youth in ultrasonogram: the upper lip organizations are divided into five layers from shallow to deep in the normal youth. The orbicularis oris of postoperative patients is interrupt and malposition. The thickness of the men and women's orbicularis oris are the same; the shallow layer shows a "among low, both sides high" form and it will become thickened in pouted state. The postoperative patients'shallow layer are thinner than the normal youth.6indexs of upper lip deformity and cicatrix width are statistically significant correlation; It is associated with better orbicularis oris plerosis, smaller cicatrix width and good hand evaluation of postoperative patients.
Conclusion:Using the Ultrasound technology to observe the orbicularis oris can obtain a clear Dimensional Ultrasonographic of the anatomical structure, it not only can be used to observe the plerosis effect of orbicularis oris, but also used to evaluate the operation effect. The orbicularis oris with cicatrix will impact the growth of the shallow layer but not the deep layer of the orbicularis oris.
引文
[1]Endriga MC, Kapp-Simon KA. Psychological issues in craniofacial care:state of the art[J]. Cleft Palate Craniofac J,1999,36(1):3-11.
[2]Jin SH, Li YM. [Repair of unilateral complete cleft lip with the method of rotation descent step by step][J]. Zhonghua Zheng Xing Wai Ke Za Zhi,2009,25(5):325-327.
[3]佘小明,杨丽,邵敏.口轮匝肌复位在单侧完全性唇裂修复术中的应用[J].华西口腔医学杂志,2005,(05)：452-453.
[4]吴安荣,何祖波,刘普岑.上唇口轮匝肌重建理念在唇裂修复中的应用[J].贵州医药,2008,(09)：813.
[5]Nicolau PJ. The orbicularis oris muscle:a functional approach to its repair in the cleft lip[J]. Br J Plast Surg,1983,36(2):141-153.
[6]黄晓红,葛志红.单侧唇裂术后继发畸形的修复[J].中国美容医学,2008,(07)：1004-1005.
[7]谢敏.口轮匝肌修复的意义与应用[J].菏泽医专学报,1992,(03)：71.
[8]王伯钧,秦小云,周思.口轮匝肌的显微解剖与临床应用[J].广西医学,2006,(03)：347-350.
[9]Kernahan DA, Bauer BS. Functional cleft lip repair:a sequential, layered closure with orbicularis muscle realignment[J]. Plast Reconstr Surg,1983,72(4):459-467.
[10]Matic DB, Power SM. Correction of the cleft lip lateral bulge deformity using anatomic muscle repair[J]. J Craniofac Surg,2011, 22(2):514-519.
[11]颜薇,赵振民,秦永平.口轮匝肌精细化解剖修复矫正单侧唇裂术后继发畸形[J].中华整形外科杂志,2010,26(4).
[12]曹东升,盛辉,汪春兰.改良Millard术式功能性修复双侧唇裂[J].中国美容医学,2007,(06)：787-788.
[13]韦强,于海生.改良皮肤切口及口轮匝肌功能性复位在双侧唇裂修复中的应用[J].中国美容医学,2009,(12)：1759-1761.
[14]张缙熙.浅表器官及组织超声诊断学[M].科学技术文献出版社,2003(10).
[15]夏田,邓典智,张三友.单侧唇裂术后效果全面评价方法的研究[J].华西口腔医学杂志,1990,(04)：287-290.
[16]M F. Anatomy and arteriography of cleft lip in stillborn children[J]. Plast Reconstr Surg,1968,42(1):29-33.
[17]张奎启,韩辉.口轮匝肌和人中形态的解剖学研究[J].中华口腔医学杂志,1990,25(6)：353-356.
[18]邓细河,徐达传,廖农.正常与单侧唇裂口轮匝肌和上唇血管的应用解剖[J].中国临床解剖学杂志,2002,20(2)：120-122.
[19]廖新红,莫春玲,韦强,韦力,陈宝峰.上唇口轮匝肌的超声解剖及声像图研究[J].广西医学,2011,33(7)：827-829.
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[21]皮昕.口腔解剖生理学[M].2007.
[22]翦新春.唇裂或唇腭裂术后继发畸形的Ⅱ期整复治疗[M].科学技术文献出版社..2010(8)
[23]王治熙,张奎启,韩辉,等.唇裂患者口轮匝肌的解剖学观察[J].中华口腔医学杂志,1994,29(1)：41-43.
[24]郑培惠,常青,林志勇.单侧唇裂患者唇部肌肉的电镜观察[J].医学影像学杂志,2004,14(4)：300-301.
[25]Willams HB. A method of assessing cleft lip repairs:comparison of LeMesurier and Millard techniques[J]. Plast Reconstr Surg,1968, 41(2):103-107.
[26]Dion MA, Parenteau J. Rotation-advancement technique in unilateral cleft lips[J]. Can J Surg,1968,11(2):177-178.
[27]Maisels DO. Early orthopaedic treatment of clefts of the primary and secondary palates:a surgeon's view[J]. Cleft Palate J,1966,3: 76-86.
[28]Joss G, Rouillard LM. A critical evaluation of the rotation-advancement (Millard) method for unilateral cleft lip repair[J].Br J Plast Surg,1962,15:349-361.
[29]Pennisi VR, Shadish WR, Klabunde EH. Orbicularis oris muscle in the cleft lip repair[J]. Cleft Palate J,1969,6:141-153.
[30]Holtmann B, Wray RC. A randomized comparison of triangular and rotation-advancement unilateral cleft lip repairs[J]. Plast Reconstr Surg,1983,71(2):172-179.
[31]Amaratunga S ea. A comparison of Millard's and LeMesurier's method of repair of the complete unilateral cleft lip using a new symmetry index[J]. J Oral Maxillofac Surg,1988,46:353-355.
[32]周文清,张翔云,吴玉兵.人体测量技术在单侧唇裂术后鼻畸形整复术的临床应用[J].大连医科大学报,2003(12),25(4)：272-274.
[33]石冰,邓典智,等.计算机辅助单侧唇裂绘图,测量及评价系统的研究[J].华西口腔医学杂志,1992,10(2)：133-135.
[34]柯杰,林珠.正常咬合人唇部形态的X线头影测量研究[J].实用口腔医学杂志,1993(7),9(3)：195-196.
[35]杨连平,孙勇刚,吕培军,等.单侧唇裂术后鼻畸形三维测量研究[J].山西医科大学学报,1998,29(1)：72-73.
[36]林立,曲延征,等.青少年单侧完全性唇腭裂患者侧面软硬组织相关性研究[J].福建医科大学学报,2008(9),42(5)：415-418.
[37]Hood CA HM, Bock M. Facial characteriazation of infants with cleft lip and palate using a three-dimensional capture technique [J]. Cleft Palate Craniofac J,2004,41(1):25-27.
[38]梁赟,杨育生,张勇,等.应用螺旋CT重建并测量单侧唇裂和唇腭裂患者畸形外鼻[J].中华口腔颌面外科杂志,2008(5),6(3)：182-187.
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[40]邓典智,李声伟,刘果生.上唇生长发育规律的探讨(成都市1500余名婴幼儿上唇生长发育的调查分析)[J].临床口腔医学杂志,1988,4(1)：17-22.
[41]刘庆丰,黎冻,韦强,等.瘢痕组织瓣旋转修复双侧唇裂继发红唇缺损[J].中华整形外科杂志,2003,19(06)：474.
[42]宋涛,尹宁北,王永前.双侧口轮匝肌粘膜瓣在双侧唇裂术后继发畸形中的应用[J].中国美容医学,2011,(03)：393-395.
[1]Endriga MC, Kapp-Simon KA. Psychological issues in craniofacial care:state of the art[J]. Cleft Palate Craniofac J,1999,36(1):3-11.
[2]Jin SH, Li YM. [Repair of unilateral complete cleft lip with the method of rotation descent step by step][J]. Zhonghua Zheng Xing Wai Ke Za Zhi,2009,25(5):325-327.
[3]佘小明,杨丽,邵敏.口轮匝肌复位在单侧完全性唇裂修复术中的应用[J].华西口腔医学杂志,2005,(05)：452-453.
[4]吴安荣,何祖波,刘普岑.上唇口轮匝肌重建理念在唇裂修复中的应用[J].贵州医药,2008,(09)：813.
[5]Nicolau PJ. The orbicularis oris muscle:a functional approach to its repair in the cleft lip[J]. Br J Plast Surg, 1983,36(2):141-153.
[6]黄晓红,葛志红.单侧唇裂术后继发畸形的修复[J].中国美容医学,2008,(07)：1004-1005.
[7]谢敏.口轮匝肌修复的意义与应用[J].菏泽医专学报,1992,(03)：71.
[8]王伯钧,秦小云,周思.口轮匝肌的显微解剖与临床应用[J].广西医学,2006,(03)：347-350.
[9]Kernahan DA, Bauer BS. Functional cleft lip repair:a sequential, layered closure with orbicularis muscle realignment[J]. Plast Reconstr Surg,1983,72(4): 459-467.
[10]Matic DB, Power SM. Correction of the cleft lip lateral bulge deformity using anatomic muscle repair[J]. J Craniofac Surg,2011,22(2):514-519.
[11]颜薇,赵振民,秦永平.口轮匝肌精细化解剖修复矫正单侧唇裂术后继发畸形[J].中华整形外科杂志,2010,26(4).
[12]曹东升,盛辉,汪春兰.改良Millard术式功能性修复双侧唇裂[J].中国美容医学,2007,(06)：787-788.
[13]韦强,于海生.改良皮肤切口及口轮匝肌功能性复位在双侧唇裂修复中的应用[J].中国美容医学,2009,(12)：1759-1761.
[14]张缙熙.浅表器官及组织超声诊断学[M].科学技术文献出版社,2003(10).
[15]夏田,邓典智.单侧唇裂术后效果全面评价方法的研究[J].华西口腔医学杂志,1990,(04)：287-290.
[16]M F. Anatomy and arteriography of cleft lip in stillborn children [J]. Plast Reconstr Surg,1968,42(1):29-33.
[17]张奎启,韩辉.口轮匝肌和人中形态的解剖学研究[J].中华口腔医学杂志,1990,25(6)：353-356.
[18]邓细河,徐达传,廖农.正常与单侧唇裂口轮匝肌和上唇血管的应用解剖[J]. 中国临床解剖学杂志,2002,20(2)120-122.
[19]皮昕.口腔解剖生理学[J].2007.
[20]翦新春.(2010(8)).唇裂或唇腭裂术后继发畸形的Ⅱ期整复治疗(科学技术文献出版社).
[21]Willams HB. A method of assessing cleft lip repairs: comparison of LeMesurier and Millard techniques [J]. Plast Reconstr Surg,1968,41(2):103-107.
[22]Dion MA, Parenteau J. Rotation-advancement technique in unilateral cleft lips[J]. Can J Surg,1968,11(2): 177-178.
[23]Maisels DO. Early orthopaedic treatment of clefts of the primary and secondary palates:a surgeon's view[J]. Cleft Palate J,1966,3:76-86.
[24]Joss G, Rouillard LM. A critical evaluation of the rotation-advancement (Millard) method for unilateral cleft lip repair[J]. Br J Plast Surg,1962,15:349-361.
[25]Pennisi VR, Shadish WR, Klabunde EH. Orbicularis oris muscle in the cleft lip repair[J]. Cleft Palate J,1969, 6:141-153.
[26]Holtmann B, Wray RC. A randomized comparison of triangular and rotation-advancement unilateral cleft lip repairs[J]. Plast Reconstr Surg,1983,71(2):172-179.
[27]周文清,张翔云,吴玉兵.人体测量技术在单侧唇裂术后鼻畸形整复术的临床应用[J].大连医科大学报,2003(12),25(4)：272-274.
[28]石冰邓典智,等.计算机辅助单侧唇裂绘图,测量及评价系统的研究[J].华西口腔医学杂志,1992,10(2)：133-135.
[29]柯杰,林珠,等.正常咬合人唇部形态的X线头影测量研究[J].实用口腔医学杂志,1993(7),9(3)：195-196.
[30]杨连平,孙勇刚,吴培军,等.单侧唇裂术后鼻畸形三维测量研究[J].山西医科大学学报,1998,29(1)：72-73.
[31]林立曲延征,等.青少年单侧完全性唇腭裂患者侧面软硬组织相关性研究[J].福建医科大学学报,2008(9),42(5)415-418.
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[34]刘庆丰,黎冻,韦强.瘢痕组织瓣旋转修复双侧唇裂继发红唇缺损[J].中华整形外科杂志,2003,19(06)：474.
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[39]王和光.我国唇腭裂治疗与研究的现状[J].中华口腔医学杂志,1998(5),33(3)：131-133.
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[48]袁云,高云,等..脂质代谢性肌肉病肌肉超声改变的研究[J].中国神经精神疾病杂志,2001,27(1)：54-55.
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[9]Kernahan DA, Bauer BS. Functional cleft lip repair:a sequential, layered closure with orbicularis muscle realignment[J]. Plast Reconstr Surg,1983,72(4):459-467.
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[11]颜薇,赵振民,秦永平.口轮匝肌精细化解剖修复矫正单侧唇裂术后继发畸形[J].中华整形外科杂志,2010,26(4).
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[28]Joss G, Rouillard LM. A critical evaluation of the rotation-advancement (Millard) method for unilateral cleft lip repair[J].Br J Plast Surg,1962,15:349-361.
[29]Pennisi VR, Shadish WR, Klabunde EH. Orbicularis oris muscle in the cleft lip repair[J]. Cleft Palate J,1969,6:141-153.
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[34]柯杰,林珠.正常咬合人唇部形态的X线头影测量研究[J].实用口腔医学杂志,1993(7),9(3)：195-196.
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[36]林立,曲延征,等.青少年单侧完全性唇腭裂患者侧面软硬组织相关性研究[J].福建医科大学学报,2008(9),42(5)：415-418.
[37]Hood CA HM, Bock M. Facial characteriazation of infants with cleft lip and palate using a three-dimensional capture technique [J]. Cleft Palate Craniofac J,2004,41(1):25-27.
[38]梁赟,杨育生,张勇,等.应用螺旋CT重建并测量单侧唇裂和唇腭裂患者畸形外鼻[J].中华口腔颌面外科杂志,2008(5),6(3)：182-187.
[39]王蕾蕾,赵振民.鼻唇部连续组织切片的计算机三维重建[J].《中国美容医学》,2011,17(11)：1635-1638.
[40]邓典智,李声伟,刘果生.上唇生长发育规律的探讨(成都市1500余名婴幼儿上唇生长发育的调查分析)[J].临床口腔医学杂志,1988,4(1)：17-22.
[41]刘庆丰,黎冻,韦强,等.瘢痕组织瓣旋转修复双侧唇裂继发红唇缺损[J].中华整形外科杂志,2003,19(06)：474.
[42]宋涛,尹宁北,王永前.双侧口轮匝肌粘膜瓣在双侧唇裂术后继发畸形中的应用[J].中国美容医学,2011,(03)：393-395.
[1]Endriga MC, Kapp-Simon KA. Psychological issues in craniofacial care:state of the art[J]. Cleft Palate Craniofac J,1999,36(1):3-11.
[2]Jin SH, Li YM. [Repair of unilateral complete cleft lip with the method of rotation descent step by step][J]. Zhonghua Zheng Xing Wai Ke Za Zhi,2009,25(5):325-327.
[3]佘小明,杨丽,邵敏.口轮匝肌复位在单侧完全性唇裂修复术中的应用[J].华西口腔医学杂志,2005,(05)：452-453.
[4]吴安荣,何祖波,刘普岑.上唇口轮匝肌重建理念在唇裂修复中的应用[J].贵州医药,2008,(09)：813.
[5]Nicolau PJ. The orbicularis oris muscle:a functional approach to its repair in the cleft lip[J]. Br J Plast Surg, 1983,36(2):141-153.
[6]黄晓红,葛志红.单侧唇裂术后继发畸形的修复[J].中国美容医学,2008,(07)：1004-1005.
[7]谢敏.口轮匝肌修复的意义与应用[J].菏泽医专学报,1992,(03)：71.
[8]王伯钧,秦小云,周思.口轮匝肌的显微解剖与临床应用[J].广西医学,2006,(03)：347-350.
[9]Kernahan DA, Bauer BS. Functional cleft lip repair:a sequential, layered closure with orbicularis muscle realignment[J]. Plast Reconstr Surg,1983,72(4): 459-467.
[10]Matic DB, Power SM. Correction of the cleft lip lateral bulge deformity using anatomic muscle repair[J]. J Craniofac Surg,2011,22(2):514-519.
[11]颜薇,赵振民,秦永平.口轮匝肌精细化解剖修复矫正单侧唇裂术后继发畸形[J].中华整形外科杂志,2010,26(4).
[12]曹东升,盛辉,汪春兰.改良Millard术式功能性修复双侧唇裂[J].中国美容医学,2007,(06)：787-788.
[13]韦强,于海生.改良皮肤切口及口轮匝肌功能性复位在双侧唇裂修复中的应用[J].中国美容医学,2009,(12)：1759-1761.
[14]张缙熙.浅表器官及组织超声诊断学[M].科学技术文献出版社,2003(10).
[15]夏田,邓典智.单侧唇裂术后效果全面评价方法的研究[J].华西口腔医学杂志,1990,(04)：287-290.
[16]M F. Anatomy and arteriography of cleft lip in stillborn children [J]. Plast Reconstr Surg,1968,42(1):29-33.
[17]张奎启,韩辉.口轮匝肌和人中形态的解剖学研究[J].中华口腔医学杂志,1990,25(6)：353-356.
[18]邓细河,徐达传,廖农.正常与单侧唇裂口轮匝肌和上唇血管的应用解剖[J]. 中国临床解剖学杂志,2002,20(2)120-122.
[19]皮昕.口腔解剖生理学[J].2007.
[20]翦新春.(2010(8)).唇裂或唇腭裂术后继发畸形的Ⅱ期整复治疗(科学技术文献出版社).
[21]Willams HB. A method of assessing cleft lip repairs: comparison of LeMesurier and Millard techniques [J]. Plast Reconstr Surg,1968,41(2):103-107.
[22]Dion MA, Parenteau J. Rotation-advancement technique in unilateral cleft lips[J]. Can J Surg,1968,11(2): 177-178.
[23]Maisels DO. Early orthopaedic treatment of clefts of the primary and secondary palates:a surgeon's view[J]. Cleft Palate J,1966,3:76-86.
[24]Joss G, Rouillard LM. A critical evaluation of the rotation-advancement (Millard) method for unilateral cleft lip repair[J]. Br J Plast Surg,1962,15:349-361.
[25]Pennisi VR, Shadish WR, Klabunde EH. Orbicularis oris muscle in the cleft lip repair[J]. Cleft Palate J,1969, 6:141-153.
[26]Holtmann B, Wray RC. A randomized comparison of triangular and rotation-advancement unilateral cleft lip repairs[J]. Plast Reconstr Surg,1983,71(2):172-179.
[27]周文清,张翔云,吴玉兵.人体测量技术在单侧唇裂术后鼻畸形整复术的临床应用[J].大连医科大学报,2003(12),25(4)：272-274.
[28]石冰邓典智,等.计算机辅助单侧唇裂绘图,测量及评价系统的研究[J].华西口腔医学杂志,1992,10(2)：133-135.
[29]柯杰,林珠,等.正常咬合人唇部形态的X线头影测量研究[J].实用口腔医学杂志,1993(7),9(3)：195-196.
[30]杨连平,孙勇刚,吴培军,等.单侧唇裂术后鼻畸形三维测量研究[J].山西医科大学学报,1998,29(1)：72-73.
[31]林立曲延征,等.青少年单侧完全性唇腭裂患者侧面软硬组织相关性研究[J].福建医科大学学报,2008(9),42(5)415-418.
[32]Hood CA HM, Bock M. Facial characteriazation of infants with cleft lip and palate using a three-dimensional capture technique[J]. Cleft Palate Craniofac J,2004, 41(1):25-27.
[33]梁赞,杨育生,张勇,等.应用螺旋CT重建并测量单侧唇裂和唇腭裂患者畸形外鼻[J].中华口腔颌面外科杂志,2008(5),6(3)：182-187.
[34]刘庆丰,黎冻,韦强.瘢痕组织瓣旋转修复双侧唇裂继发红唇缺损[J].中华整形外科杂志,2003,19(06)：474.
[35]宋涛,尹宁北,王永前.双侧口轮匝肌粘膜瓣在双侧唇裂术后继发畸形中的应用[J].中国美容医学,2011,(03)：393-395.
[36]魏奉才,公茂来.(2002).美容整形外科学(北京,人民卫生出版社).
[37]王国义,阎俊新.(2009).实用口腔颌面颈部手术图谱(军事医学科学出版社).
[38]王治熙,张奎启,韩辉,等.唇裂患者口轮匝肌的解剖学观察[J].中华口腔医学杂志,1994,29(1)：41-43.
[39]王和光.我国唇腭裂治疗与研究的现状[J].中华口腔医学杂志,1998(5),33(3)：131-133.
[40]Amaratunga S ea. A comparison of Millard's and LeMesurier's method of repair of the complete unilateral cleft lip using a new symmetry index[J]. J Oral Maxillofac Surg,1988,46:353-355.
[41]石冰邓典智,等.单侧唇裂术后效果全面评价方法的研究[J].华西口腔医学杂志,1990,8(4)：287-290.
[42]邓典智.先天性单侧唇裂畸形特点的研究[J].华西口腔医学杂志,1989,7(3)：129-132.
[43]黄洪章,胡松柏,段昌华,等.儿童与成人单侧唇裂术后鼻畸形形态测量的研究[J].实用口腔医学杂志,1993,9(4)：258-262.
[44]石冰邓典智,等.用唇裂术后评价方法检测正常人面部生长发育变化[J].口腔医学纵横杂志,1994,10(1)：4-6.
[45]周先略.BP神经网络的单侧唇裂手术效果预测研究[J].临床口腔医学杂志,2009(3),25(3)：168-169.
[46]惠莲.神经电图在口轮匝肌双侧同时记录意义的探讨[J].耳鼻喉学报,1998,12(1)：7-9.
[47]郑培惠,等. 双侧完全性唇裂肌功能整复术后的肌电活动研究[J].上海口腔医学,2004(10),13(5)：371-374.
[48]袁云,高云,等..脂质代谢性肌肉病肌肉超声改变的研究[J].中国神经精神疾病杂志,2001,27(1)：54-55.