Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지

SECONDARY CHEILORHINOPLASTY OF BILATERAL CLEFT LIP AND NOSE DEFORMITIES

양측성 구순 비변형 환자의 이차 구순비성형술

  • Kim, Jong-Ryoul (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Hwang, Dae-Seok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University)
  • 김종렬 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 황대석 (부산대학교 치과대학 구강악안면외과학교실)
  • Published : 2007.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

Keywords

References

  1. Bardach J, Salyer K : Surgical techniques in cleft lip and palate. Chapter 5. Year Book Medical Publishers, 1986, p.157
  2. Jackson IT, Yavuzer R, Kelly C et al : The central lip flap and nasal mucosal rotation advancement : Important Aspects of Composite Correction of the Bilateral Cleft Lip Nose Deformity. J Craniofac Surg 16(2) : 255, 2005 https://doi.org/10.1097/00001665-200503000-00011
  3. Millard DR : Closure of bilateral cleft lip and elongation of columella by two operations in infancy. Plast Reconstr Surg 47 : 324, 1971 https://doi.org/10.1097/00006534-197104000-00004
  4. Cronin TD, Upton J : Lengthening of the short columella associated with bilateral cleft lip. Ann Plast Surg 1 : 75, 1978 https://doi.org/10.1097/00000637-197801000-00015
  5. McComb H : Primary repair of the bilateral cleft lip nose : a 15-year review and a new treatment plan. Plast Reconstr Surg 86 : 882, 1990
  6. Gensoul M : Reduction of a thickened columella and advancing the point of the nose. J Univ Hebd Med Prat 12 : 29, 1983
  7. Ozaki W, Richard C, Kim CV et al : Comprehensive rhinoplasty technique to correct the bilateral to correct the bilateral cleft lip nasal deformity using conchal composite grafts. J Craniofac Surg 34 : 150, 2006
  8. Salyer KE, Bardach J : Salyer and Bardch's atlas of craniofacial and cleft surgery. Vol II. Lippincott-Ravern, Philadelphia, New York, 1988, p.423
  9. Millard DR : Earlier correction of the unilateral cleft lip nose. Plast Reconstr Surg 70 : 64, 1982 https://doi.org/10.1097/00006534-198207000-00014
  10. Ryu SY : A comparative study on the correction methods nostril in patients with cleft lip nasal deformity. J Kor Oral Maxillofac Surg 32 : 287, 2006
  11. McComb H : Primary repair of the bilateral cleft lip nose : a 15-year review and a new treatment plan. Plast Reconstr Surg 86 : 882, 1990
  12. Mulliken JB : Bilateral complete cleft lip and nasal deformity : an anthropometric analysis of staged to synchronous repair. Plast Reconstr Surg 96 : 9, 1995 https://doi.org/10.1097/00006534-199507000-00002
  13. Mulliken JB, Wu JK, Padwa BL : Repair of bilateral cleft lip : Review, Revisions, and Reflections. J Craniofac Surg 14(5) : 609, 2003 https://doi.org/10.1097/00001665-200309000-00003
  14. Trott JA, Mohan N : A preliminary report on open tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate : the Alor Setar experience. Br J Plast Surg 46 : 215, 1993 https://doi.org/10.1016/0007-1226(93)90171-7
  15. Cutting C, Grayson B, Brecht L : Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair. Plast Reconstr Surg 101 : 630, 1998 https://doi.org/10.1097/00006534-199803000-00009
  16. Grayson BH, Santiago PE, Brecht LE et al : Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 36 : 486, 1999 https://doi.org/10.1597/1545-1569(1999)036<0486:PNMIIW>2.3.CO;2
  17. Lee KJ : Comprehensive surgical atlases in otolaryngology and head and neck surgery. Chapter 15, Grune & Stratton, 1983, p.307
  18. Cutting C, Grayson B : The prolabial unwinding flap method for one stage repair of bilateral cleft lip nose and alveolus. Plast Reconstr Surg 91 : 37, 1993 https://doi.org/10.1097/00006534-199301000-00006