Biomechanical analyses of common suspension sutures in primary cleft lip rhinoplasty
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RESEARCH
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Biomechanical analyses of common suspension sutures in primary cleft lip rhinoplasty Hanyao Huang, Xu Cheng, Xiangyou Luo, Bing Shi and Jingtao Li*
Abstract Background: For a better understanding of common suspension sutures during primary cleft lip nasal rhinoplasty, the biomechanical consequences of those sutures need to be demonstrated. Methods: A finite element model of the infant specimen was established. The closure of cleft lip and four different specific suspension sutures were simulated by loading different forces on the model: 1. F1 to simulate the suture fastening both medial crura together; 2. F2 to simulate the suture which sewed both medial crura and the noncleft-side upper lateral cartilage together; 3. F3 to simulate the suture elevating the alar cartilage cranially; 4. F4 to simulate the suture elevating the alar cartilage superiorly. The deformation and stress distribution consequent to each maneuver were analyzed in details. Results: The deviation of columella was restored through the closure of cleft lip. Different suspension sutures had different biomechanical effects on the nasal structure. All suspension sutures had the function on elevating the alar cartilage. F2 had no function on restoring the collapse of the nasal tip. The suture which fastened both medial crura together leaded to the lowest stress on the skin envelope. Conclusions: Each suspension suture had its characteristics respectively. The simulation suggested that F1, the suture which fastened both medial crura, could be the most potential maneuver for cleft lip rhinoplasty because it can symmetrically restore the shape of the nose without incurring a significant increase in stress. Keywords: Cleft lip, Nasal deformity, Rhinoplasty, Finite element analysis, Biomechanics
Background Cleft lip deformity is a most common congenital craniofacial defect in human [1], while the cleft lip nasal deformity is one of the greatest challenges to cleft surgeons [2, 3]. Different surgical maneuvers have been applied to restore the anatomical nasal structure, but the outcomes were indistinguishable because most of the analyses for surgical outcomes were retrospective and the measurement criteria were arduous to unify. Choosing an appropriate maneuver guarantees the favorable surgery effect. The biomechanics for cleft lip nose correction and a better understanding of different
* Correspondence: [email protected] State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road, Chengdu 610041, China
surgical maneuvers should be considered as the primary requirement. Early physical simulations illustrated that the cartilages framework was correlated to the shape of the nose, but the mechanisms were not demonstrated specifically [4]. For understanding the biomechanics of rhinoplasty better, finite element analyses have been validated as a rewarding method [5–13]. Our recent st
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