AbstractThe lip-splitting approach enables excellent access to all areas of the mouth and pharynx to remove tumors; however, traditional lower lip-splitting incisions produce an unsatisfactory scar. To achieve better functional and aesthetic results, we used a Z-shaped incision and compared the functional and aesthetic outcomes of the straight and Z-shaped incisions.

摘要唇裂方法可以很好地进入口腔和咽部的所有区域以去除肿瘤；然而，传统的下唇裂开切口产生不令人满意的疤痕。为了获得更好的功能和美学效果，我们使用了Z形切口，并比较了直切口和Z形切口的功能和美学效果。

Sixty patients who fulfilled the inclusion criteria were randomly divided into two groups and underwent lip-splitting between March 2021 and September 2023. Eventually, 77 patients were reviewed within 6 months and evaluated using the lip function assessment scale, patient and observer scar assessment scale, naïve observer scar assessment scale, and a clinical examination.

符合纳入标准的60名患者被随机分为两组，并在2021年3月至2023年9月期间接受了唇裂手术。最终，在6个月内对77名患者进行了复查，并使用唇功能评估量表，患者和观察者瘢痕评估量表，幼稚观察者瘢痕评估量表和临床检查进行了评估。

The Z-shaped incision group performed better in terms of the lip pout movement at 3 months and in the subjective overall opinion, color, irregularity, and pigmentation at 6 months. The Z-shaped incision group had a lower incidence of notched vermilion. In conclusion, Z-shaped lower lip-splitting incisions have better functional and aesthetic outcomes than traditional straight incisions.Trial registration: Public title: Difference between the effect of Z-shaped and vertical incisions of labiobuccal flap on the recovery of lower lip scars.

Z形切口组在3个月时的唇撅运动以及6个月时的主观总体意见，颜色，不规则和色素沉着方面表现更好。Z形切口组切口朱红的发生率较低。总之，Z形下唇分裂切口比传统的直切口具有更好的功能和美学效果。试验注册：公开标题：唇颊瓣Z形和垂直切口对下唇瘢痕恢复的影响之间的差异。

Registration date: 09/03/2021. Registration number: ChiCTR2100044084. Registry URL: http://www.chictr.org.cn..

Registration date: 09/03/2021. Registration number: ChiCTR2100044084. Registry URL: http://www.chictr.org.cn..

IntroductionThree-dimensional extirpation of tumors with safe surgical margins while maintaining function and cosmesis after ablative surgical procedures is important in oral and maxillofacial surgery. However, nothing compares with the direct surgical field offered by a lower lip-splitting incision in terms of visual access, haptics, and vessel control1, especially when the lesion involves the maxilla, maxillary gingiva, and hard or soft palate2.

引言在口腔颌面外科手术中，在消融手术后保持功能和美容的同时，以安全的手术切缘三维切除肿瘤是重要的。然而，在视觉通路，触觉和血管控制方面，没有什么能与下唇裂开切口提供的直接手术区域相比，特别是当病变涉及上颌骨，上颌牙龈和硬腭或软腭时。

However, this approach inevitably causes aesthetic and functional problems such as unsightly scars, vermilion notching, chin-pad contour loss, dwindled lip sensation, lip mobility, and oral commissure incontinence3.The lower lip-splitting procedure has been widely used in oral and maxillofacial surgery since it was first described in mid-nineteenth century.

然而，这种方法不可避免地会导致美学和功能问题，例如难看的疤痕，朱红色的凹痕，下巴垫轮廓丧失，嘴唇感觉减弱，嘴唇活动性和口腔连合失禁3。下唇裂开手术自19世纪中期首次被描述以来，已被广泛用于口腔颌面外科。

It was later modified by Robson4, McGregor and McDonald5, Ramon6, Rassekh7, and Hayter8 in attempts to improve postoperative function and appearance. These modification strategies include using a relaxed skin tension line, hiding in the contour of the chin protuberance, reducing muscle fiber damage, and avoiding a straight-line incision across the lip.

后来被Robson4，McGregor和McDonald5，Ramon6，Rassekh7和Hayter8修改，试图改善术后功能和外观。这些修改策略包括使用松弛的皮肤张力线，隐藏在下巴突起的轮廓中，减少肌肉纤维的损伤，以及避免在嘴唇上形成直线切口。

These are said to be effective, although there have been insufficient clinical trials. However, we believe that the best strategy among them is avoiding a straight-line incision across the lip because it limits wound contraction, which has been proven by fundamental research9. Therefore, we applied the Z-plasty technique to the lower lip-splitting incision and named it the Z-shaped incision.

尽管临床试验不足，但据说这些方法是有效的。然而，我们认为其中最好的策略是避免在嘴唇上进行直线切口，因为它限制了伤口收缩，这已被基础研究证实9。因此，我们将Z成形术应用于下唇裂口切口，并将其命名为Z形切口。

The biggest difference between the design of the Z-shaped incision and that of the straight-line incision is that the Z-shaped incision completely abandons the continuous straight line. This novel incision design includes the following: (.

Z形切口的设计与直线切口的设计之间的最大区别是Z形切口完全放弃了连续的直线。这种新颖的切口设计包括以下内容：（。

1.

1.

Patient data: Patient’s clinical data were collected, including age, sex, diagnosis, pathology, systemic disease, surgical procedures (operation time, reconstruction, neck dissection, mandibulotomy, or mandibulectomy), recurrence, and adverse events (vascular crisis, infection, bleeding or hematoma, fistula, etc.)..

患者数据：收集患者的临床数据，包括年龄，性别，诊断，病理学，全身性疾病，外科手术（手术时间，重建，颈清扫，下颌骨切开术或下颌骨切除术），复发和不良事件（血管危象，感染，出血或血肿，瘘管等）。。

2.

2.

Images: The patient's head-on, left oblique, and right oblique photos were taken 1 day before surgery and 7 days, 1 month, 3 months, and 6 months after the patient’s review. Each patient was photographed in a specific photo studio with a black background and a dedicated camera (M stop, shutter speed 1/100 s, aperture F10, ISO400), using a ring light..

图像：患者的正面，左斜和右斜照片是在手术前1天以及患者复查后7天，1个月，3个月和6个月拍摄的。每位患者都是在一个特定的摄影棚中拍摄的，该摄影棚有一个黑色背景和一个专用相机（M stop，快门速度1/100 s，光圈F10，ISO400），使用环形灯。。

3.

3.

Lip function evaluation: Lip function was evaluated using the Lip Function Assessment Scale, which contains eight items, each ranking on five levels. Higher scores indicated better function (Supplementary Table 1).

唇部功能评估：使用唇部功能评估量表评估唇部功能，该量表包含八个项目，每个项目分为五个级别。分数越高表示功能越好（补充表1）。

4.

4.

Scar evaluation: Scar formation was evaluated by the POSAS (Patient and Observer Scar Assessment Scale v2.0), with lower scores indicating better outcomes (Supplementary Tables 1–4).

瘢痕评估：通过POSAS（患者和观察者瘢痕评估量表v2.0）评估瘢痕形成，分数越低表示结果越好（补充表1-4）。

5.

5.

Photographic analysis by naïve viewers: Patients’ head-on photographs at 6 months were viewed by three viewers who did not have any routine exposure to patients with head and neck cancer; photographs were assessed according to the naïve observer scar assessment scale (NOSAS; Supplementary Table 4).

天真观众的照片分析：三名观众观看了6个月时患者的正面照片，他们没有常规接触头颈癌患者；根据幼稚观察者瘢痕评估量表（NOSAS；补充表4）评估照片。

6.

6.

Clinical examination: Notched vermilion, groove formation, and sensory disorders were assessed, as shown in Supplementary Table 5. Sensory disorder assessment was performed using a dental probe that stabbed normal skin and scar areas with the same strength.

临床检查：如补充表5所示，评估了缺口朱红色，凹槽形成和感觉障碍。使用牙科探针进行感觉障碍评估，该探针以相同的强度刺穿正常皮肤和疤痕区域。

Wound care and follow-up carePatients are advised not to use topical drugs throughout the perioperative and follow-up periods, and not to use additional skin care products after wound healing. The study was stopped when sufficient samples were collected.Statistical analysisOrdinal data were analyzed using the Mann–Whitney U test.

伤口护理和随访护理建议患者在围手术期和随访期间不要使用局部药物，并且在伤口愈合后不要使用额外的皮肤护理产品。当收集到足够的样本时，研究停止。统计分析使用Mann-Whitney U检验分析序数数据。

Categorical data were analyzed using the chi-squared test or Fisher’s exact test. Repeated measured data was analyzed using generalized estimating equations. Missing values occurred randomly due to patient dropout, and as their presence did not affect the analysis of Generalized Estimating Equations, no imputation was performed.

使用卡方检验或Fisher精确检验分析分类数据。使用广义估计方程分析重复测量的数据。由于患者辍学，缺失值随机发生，并且由于它们的存在不影响广义估计方程的分析，因此不进行插补。

Software used in the analysis were SPSS version 17.0 and GraphPad Prism version 5.0. A p-value < 0.05 was considered to be statistically significant.Bias controlWe mitigated potential risks through the application of randomization, the use of established assessment scales, and the establishment of stringent execution standards.

分析中使用的软件是SPSS 17.0版和GraphPad Prism 5.0版。p值<0.05被认为具有统计学意义。偏差控制我们通过应用随机化，使用既定的评估量表以及建立严格的执行标准来减轻潜在风险。

Surgeon was unaware of the surgical procedure for each patient until they opened the envelope on the day of surgery. Postoperative evaluations were conducted by single, independent assessor. However, due to the visibility of the scar location, there was an inherent element of information bias. In the research process, we proactively contacted patients via telephone to remind them of their follow-ups, and those who were long-term lost to follow-up would be removed from the research.Surgical procedureStraight incisionThe incision started from the vermilion border, moved down along a straight vertical incision, and was continued with a collar incision (Fig. 2A).Figure 2Straight incision (A) and Z-shaped incision (B).Full size imageZ-shaped incisionThe incision sloped down from the vermilion border t.

外科医生在手术当天打开信封之前并不知道每位患者的手术程序。术后评估由单一的独立评估员进行。然而，由于疤痕位置的可见度，存在信息偏差的固有因素。在研究过程中，我们通过电话主动联系患者，提醒他们进行随访，长期失访的患者将被排除在研究之外。外科手术切口切口从朱红色边缘开始，沿着笔直的垂直切口向下移动，并继续用领口切口（图2A）。图2直切口（A）和Z形切口（B）。全尺寸imageZ形切口切口从朱红色边缘向下倾斜。

Table 1 Patients profile.Full size tableFigure 3Digital image of patients who had undergone straight lower lip-splitting incision (A,C,E) and Z-shaped lower lip-splitting incision (B,D,F).Full size imageEvaluation of postoperative lip competenceWe followed up the patients and analyzed the data based on time points.

表1患者概况。全尺寸表图3经历过直下唇裂开切口（A，C，E）和Z形下唇裂开切口（B，D，F）的患者的数字图像。术后唇部功能的全尺寸图像评估我们对患者进行了随访，并根据时间点分析了数据。

As shown in Fig. 4 (a higher score indicates better function), the Z-shaped incision group performed better than the straight incision group. The total scores on the lip function assessment scale also showed significant difference between the two groups (Table 2).Figure 4Lip function assessment scale result.

如图4所示（分数越高表示功能越好），Z形切口组的表现优于直切口组。唇功能评估量表的总分也显示出两组之间的显着差异（表2）。图4Lip功能评估量表结果。

*Represents P < 0.05. **Represents P < 0.01.Full size imageTable 2 Scar assessment scale scores.Full size tableEvaluation of postoperative scar formationThe total PSAS scores didn’t show significantly different between the Z-shaped and straight incision groups (Table 2, Fig. 5). Regarding the OSAS, the total scores didn’t show significant differences between the two groups either (Fig.

*代表P<0.05**代表P<0.01。全尺寸imageTable 2疤痕评估量表评分。全尺寸表术后瘢痕形成的评估Z形切口组和直切口组的总PSAS评分没有显着差异（表2，图5）。关于OSAS，两组之间的总分也没有显着差异（图）。

6). There was a bias in the study because the study design did not blind the assessors. Therefore, to obtain credible results, we used the NOSAS and found that the results showed significant difference (Table 2).Evaluation of clinical examinationWe further assessed notched vermilion, groove formation, and sensory disorders that were not considered in the POSAS and NOSAS (Table 3).

6） 。这项研究存在偏见，因为研究设计并没有使评估者失明。因此，为了获得可靠的结果，我们使用了NOSA，发现结果显示出显着差异（表2）。临床检查的评估我们进一步评估了POSAS和NOSA中未考虑的切迹朱红色，凹槽形成和感觉障碍（表3）。

As expected, the notched vermilion incidence was significantly lower in the Z-shaped group, while groove formation did not show a significant difference. Regarding sensory disorders, most patients (85%) showed noticeably better performance at 6 months than at 7 days; however, there was no significant difference between the two groups..

正如预期的那样，Z形组的缺口朱红色发生率显着降低，而凹槽形成没有显示出显着差异。关于感觉障碍，大多数患者（85%）在6个月时的表现明显优于7天；然而，两组之间没有显着差异。。

Table 3 Clinical examination.Full size tableFigure 5Patient scar assessment scale results. *Represents P < 0.05. **Represents P < 0.01.Full size imageFigure 6Observer scar assessment results.Full size imageOther possible factorsIn the case of other potentially affecting factors, we further collected operation variables, such as operation time, reconstruction type, neck dissection type, and mandible disposal (Supplementary Table 6).

表3临床检查。全尺寸表图5患者瘢痕评估量表结果*代表P<0.05**代表P<0.01。全尺寸图像图6观察者瘢痕评估结果。全尺寸图像其他可能的因素在其他潜在影响因素的情况下，我们进一步收集了手术变量，如手术时间，重建类型，颈清扫类型和下颌骨处理（补充表6）。

Multivariate logistic regression was used to analyze the relationship between the operational variables and the total scores of the scales; no significant differences were found.DiscussionIn this study, the novel Z-shaped incision was found to have significantly better functional and aesthetic outcomes than the traditional straight incision, suggesting that the Z-shaped incision may be used as an alternative to the traditional vertical incision for conventional lower lip incisions.

多因素logistic回归用于分析操作变量与量表总分之间的关系；没有发现显着差异。讨论在这项研究中，发现新型Z形切口比传统的直切口具有更好的功能和美学效果，这表明Z形切口可以用作传统垂直切口的替代方法，用于传统的下唇切口。

There are some limitations to this study: firstly, our study was a single-center study, the relatively small sample size collected might limit the statistical power of the study; and it may not generalize to a broader population due to potential selection biases in patient enrollment; and constraints in resources and expertise could have led to limitations in the study design, data collection, and analysis.

这项研究有一些局限性：首先，我们的研究是一项单中心研究，收集的样本量相对较小可能会限制研究的统计能力；由于患者登记中潜在的选择偏差，它可能不会推广到更广泛的人群；资源和专业知识的限制可能导致研究设计，数据收集和分析的局限性。

These aspects should be considered in the interpretation of the findings. Secondly, Due to financial and time constraints, as well as the nature of the research design, our sample size and follow-up time have obvious disadvantages compared to other retrospective studies, which may affect the statistical power of the study, making it difficult to draw definitive conclusions; further expansion of the sample size and follow-up time could provide a more solid basis .

在解释调查结果时应考虑这些方面。其次，由于财务和时间的限制，以及研究设计的性质，我们的样本量和随访时间与其他回顾性研究相比有明显的缺点，这可能会影响研究的统计能力，难以得出明确的结论；进一步扩大样本量和随访时间可以提供更坚实的基础。

Data availability

数据可用性

Contact the first or corresponding author for data and materials.

联系第一作者或通讯作者以获取数据和材料。

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Download referencesAcknowledgementsWe are grateful to Tang, Liao, Liu, Huang, Hou, Shuai, Qiao, and Ma for their contributions.FundingThis study was funded by the Department of Science and Technology Application Fundamental Project of the Sichuan Province (grant number 2021YJ0129).Author informationAuthor notesThese authors contributed equally: Cheng Miao and Ying Zheng.Authors and AffiliationsState Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, ChinaCheng Miao, Zhongkai Ma, Lu Bai, Longjiang Li & Chunjie LiDepartment of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, ChinaCheng Miao, Zhongkai Ma, Longjiang Li & Chunjie LiDivision for Globalization Initiative, Tohoku University Graduate School of Dentistry, Sendai, JapanCheng Miao & Guang HongChengdu Sixth People’s Hospital, Chengdu, Sichuan, ChinaYing ZhengWest China School of Nursing, Sichuan University, Chengdu, ChinaYing Zheng & Lu BaiAuthorsCheng MiaoView author publicationsYou can also search for this author in.

下载参考文献致谢我们感谢唐，廖，刘，黄，侯，帅，乔和马的贡献。资助本研究由四川省科学技术应用基础项目（批准号2021YJ0129）资助。作者信息作者注意到这些作者做出了同样的贡献：程淼和郑颖。作者和单位四川大学华西口腔医院口腔疾病国家重点实验室、国家口腔医学中心和国家口腔疾病临床研究中心，成都，中国城苗、马仲恺、鲁白、李龙江和李春杰四川大学华西口腔医院头颈肿瘤学系，成都，中国城苗、马仲恺、李龙江和李春杰全球化倡议科，东北大学牙科研究生院，仙台，日本城苗和广洪成都第六人民医院，四川成都，中国应政四川大学华西护理学院，成都，中国应政和Lu Bai作者Cheng MiaoView作者出版物您也可以在中搜索此作者。

PubMed Google ScholarYing ZhengView author publicationsYou can also search for this author in

PubMed Google ScholarYing ZhengView作者出版物您也可以在

PubMed Google ScholarZhongkai MaView author publicationsYou can also search for this author in

PubMed谷歌学者仲恺MaView作者出版物您也可以在

PubMed Google ScholarLu BaiView author publicationsYou can also search for this author in

PubMed Google ScholarLu BaiView作者出版物您也可以在

PubMed Google ScholarGuang HongView author publicationsYou can also search for this author in

PubMed Google ScholarGuang HongView作者出版物您也可以在

PubMed Google ScholarLongjiang LiView author publicationsYou can also search for this author in

PubMed谷歌学术龙江LiView作者出版物您也可以在

PubMed Google ScholarChunjie LiView author publicationsYou can also search for this author in

PubMed Google ScholarChunjie LiView作者出版物您也可以在

PubMed Google ScholarContributionsCheng Miao, Chunjie Li, and Longjiang Li were responsible for the design of the experiment; Zhongkai Ma and Guang Hong were responsible for the inclusion and exclusion of patients; Cheng Miao, Ying Zheng, and Lu Bai were responsible for patients’ follow-up, evaluation, and data collection; and Cheng Miao and Ying Zheng were responsible for analyzing the data, drawing tables, and completing the writing and revision of the article.

PubMed谷歌学术贡献Scheng Miao，Chunjie Li和Longjiang Li负责实验的设计；马仲恺和广红负责纳入和排除患者；程淼，郑颖和陆白负责患者的随访，评估和数据收集；程淼和郑颖负责分析数据，绘制表格，并完成文章的撰写和修订。

Chunjie Li was responsible for reviewing and submitting the paper, and all authors have read and agreed to the publication of the article. All patients provided informed consent.Corresponding authorsCorrespondence to.

李春杰负责审查和提交论文，所有作者都阅读并同意发表文章。所有患者均提供知情同意书。通讯作者通讯。

Longjiang Li or Chunjie Li.Ethics declarations

李龙江或李春杰。道德宣言

Competing interests

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Reprints and permissionsAbout this articleCite this articleMiao, C., Zheng, Y., Ma, Z. et al. Functional and aesthetic results of the Z-shaped and straight lower lip-splitting incision: a randomized clinical trial.

转载和许可本文引用本文Miao，C.，Zheng，Y.，Ma，Z。等人。Z形和直下唇分裂切口的功能和美学结果：一项随机临床试验。

Sci Rep 14, 18699 (2024). https://doi.org/10.1038/s41598-024-63983-zDownload citationReceived: 03 October 2023Accepted: 04 June 2024Published: 12 August 2024DOI: https://doi.org/10.1038/s41598-024-63983-zShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1418699（2024）。https://doi.org/10.1038/s41598-024-63983-zDownload引文接收日期：2023年10月3日接收日期：2024年6月4日发布日期：2024年8月12日OI：https://doi.org/10.1038/s41598-024-63983-zShare本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsSurgical woundLower lip-splitting incisionReconstructive surgical proceduresMaxillofacial surgery

关键词手术性下唇裂切口重建手术程序颌面外科

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