Mulliken변법을 이용한 양측성 구순열의 교정

Abstract

Mulliken의 최신 양측성 완전구순열교정법을 우리나라 어린이에 적용시켜 보았을 때 문제점들이 발견되어 변법을 고안하였다. 첫째, 외비절개를 비내절개로 바꾸었으며, 둘째, 전진피판의 수평 절개를 비익 안에서 짧게 하였으며, 셋째, 외측 구순분절 피부로부터의 구륜근 박리를 보존적으로 하였고, 넷째, 비익연골의 직접봉합술 대신 봉양술을 하였고, 다섯째, 전순피판을 조금 더 크게 만들었으며, 여섯째, 인중 함몰을 위해 새로운 봉합법을 고안하였다. 그 결과 코 길이, 비첨 돌출, 비주 폭 등은 적절하였으며, 구순비의 대칭성이 잘 유지되고, 정중 홍순결절도 잘 형성되었으며, 인중의 모양도 자연스러웠다. 그러나, 코 끝이 두측으로 과도하게 올라감으로써 비순각이 너무 컸으며, 시간이 지남에 따라 비익기저간격이 조금 더 넓어지는 경향이 있었다.

The authors had been operating on bilateral cleft lip, alveolus, and nose by the Mulliken method to correct the synchronous nasolabial repair without producing a fork flap, but found several problems with this method when applied to oriental infants. To create a more appropriate surgical technique for Korean infants, we made several modifications in the Mulliken mothod. There are six parts of modified method. First, the dislocated alar cartilages were approached through the base of prolabial flap instead of alar rim and vertical tip incisions. Second, we made short incisions of lateral lip segments between both alae. Third, the dissection of the orbicularis oris muscle was conservatively. Fourth, we sutured the alar cartilages to one another and suspended them to the upper lateral cartilage by means of cinching. Fifth, the prolabial flap was made larger than suggested by Mulliken. Sixth, we sutured the prolabial flap to lateral lip segments, lower by as much as 1 mm. We corrected bilateral cleft of 8 males and 6 females aged between 3 and 6 months(mean 4.4 months) with modified Mulliken method. A technique for primary lip and nasal correction are detailed. An aesthetically almost definitive lip and nose were obtained in all cases after an average follow-up period of 25.5 months. The nasal length, nasal tip projection, and columella width were appropriate, median vermillion tubercle was well formed, and the shape of the philtrum was natural. However, the tip of the nose pointed cranially so that it made the nasolabial angle large, and the interalar base distance had the tendency to become wider with time Key Words: Bilateral cleft lip, One stage repair, Mulliken method