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제목 |
Surgical treatment of lip & nasolabial fold deformities in Hansen's Disease |
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저자 |
Sung Yul Ahn, Hang Joon Park# |
소속 |
Ahn's plastic & esthetic surgery clinic. Seoul, Korea, and Dept. of Dermatology, Dankuk University#, Chonan, Korea |
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년도 |
1998 |
권 |
31 |
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호 |
2 |
번호 |
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시작페이지 |
41 |
끝페이지 |
55 |
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첨부 |
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요약 |
In leprosy patients with facial nerve palsy. we frequently see deformities such as
drooping, eversion of the lower lip and unilateral or bilateral effacement of the nasolabial
fold in the perioral area. These features require corrective actions for both functional
and aesthetic purposes.
The traditional methods for correcting the asymmetry of the paralysed face are static
and dynamic techniques. Static methods attempts to elevate the corner of the mouth
using a sling of fascia lata suspended from the zygoma. Dynamic methods provide
symmetry at rest with temporal or masseter muscle transfer while also providing facial
motion.
Recent neural procedures to restore impulse from the intact ipsilateral or contralateral
facial nerve can give the best results in facial paralysis for normal patients suffering
from nerve damage(e.g., surgical trauma, injury, etc,). Unfortunately, these procedures
are not indicated for leprosy patients whose nerve damages are resulted from the
infiltration of lepra bacilli.
Having not received satisfying results from the traditional methods. We developed a
new approach in surgery using a basic static method but coupled with a do-epithelized
nasolabial flap.
To correct the drooping of the lower lip while avoiding the need for a facia lata or a
sling material such as Goretex, we created the de-epithelized nasolabial flap technique.
A de-epithelized nasolabial flap is passed around the corner of the mouth and attached
at the mid-point under the lower lip in unilateral involvement. Cross-connections are
used in bilateral ones. Then, the flap is suspended to the zygoma at two points with
3-0 nylon and creates a nasolabial fold.
The skin is closed over the buried flap which creates more volume in the nasolabial
fold. The length of the lower lip was reduced using wedge excision. Correction of the
droop in the central portion of the lower lip was achieved through Z-plasty and
deliberate dog-earring to push the lip upwards. The author have employed this
procedure in 24 patients over the past four and half years. I received satisfactory results
in all cases. Less than 10% of the patients experienced a recurrence of laxity over time
that required additional surgery. |
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내용 |
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