직선봉합법을 이용한 대구증의 교정

Abstract

Macrostomia is a relatively rare malformation. There have been many surgical methods for the correction of macrostomia. The old method, a simple straight line closure , did not include reconstruction of the orbicularis oris muscle. Postoperatively, a depressed scar and severe contraction on the cheek were found, especially with animation. As a result, many authors have known that reconstruction of the orbicularis oris muscle was very important to avoid a depressed scar for the correction of macrostomia. The tendency toward lateral displacement of the reconstructed commissure has been attributed to linear scar contraction, and Z-plasty is advocated to prevent this deformity. However, we found that the Z-plasty scar may be conspicuous when the patient smiles. So we performed reconstruction of the orbicularis oris muscle to avoid a depressed scar, and straight line closure to avoid a conspicuous scar. In order to prevent linear scar contracture due to straight line closure, we overcorrected the new commissure. We treated 6 cases of macrostomia form May 1, 1996 to April 30, 1999 using straight line closure and reconstruction of the orbicularis oris muscle. Periods of follow-up were from 12 months to 35 months, with an average of 20,2 months. Every patient was analyzed clinically by ordinary scale method and anthropometrically by the ratio of abnormal distances to normal distances between cheilion and crista philtri. In 3 clinical assessments : symmetry of the commissure was excellent: degree of the scar at rest was good: and degree of depression with animation was excellent. The anthropometrical ratio was 1:1.05. Despite the fact that the linear scars were perpendicular to the minimal skin tension lines, the scars were inconspicuous. The muscle repair provided reconstruction to the modiolus and gave a natural appearance to the commissure, however it did not seem to provide sufficient bulkiness around the commissure. The straight line skin closure and repair of the orbicularis oris muscle provide effective functional and aesthetic reconstruction.

저자들은 대구증의 기존 교정법 가운데 가장 흔히 사용되던 Z성형술의 단점인 반흔을 해결하기 위해 직선봉합법을 이용하여 6명의 대구증을 교정하였다. 동시에 구륜근을 재건하여 괄약근으로서의 기능을 복구시킴과 동시에 와우축을 재건함으로써 협부함몰의 교정을 도모하였으며, 습부 홍순 전체를 피판으로 일으켜 구강점막과 구각을 만듦으로써 자연스러운 구각을 만들 수 있었다. 구륜근 재건만으로 교정되지 않는 심한 협부함몰은 피하지방판으로 보충시켰다. 수술 결과, 직전 봉합법을 이용한 방법은 휴지기는 물론이고 표정을 지을 때도 반흔이 덜 두드러졌으며, 인체계측법으로 조사해 보았을 때 입술의 대칭이 잘 유지되었으므로 대구증의 교정에 효과적인 것을 알 수 있었다.