• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.19-22
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• 2010

The author presents a new method for the formation of Cupid's bow and the vermilion tubercle by using the inferior-based lip skin flap in a secondary bilateral cleft lip deformity. The length of the flap includes the entire length of the previous upper lip scar. Both skin flaps are elevated and turned down toward the central part of the vermilion. The distant portion of the turned-down skin flaps are deepithelialized and trimmed according to the new shape of Cupid's bow. The deepithelialized portions of both flaps are buried under the central vermilion mucosa in order to create the vermilion tubercle. The advantages of the proposed procedure are; provision of a more natural shape of Cupid's bow, the lip length is increased, and the vermilion tubercle can be reconstructed at the same time. Therefore, this technique is best suited for a case of a bilateral absence of Cupid's bow combined with a short lip in a sufficient upper lip of a bilateral cleft lip deformity. The proposed procedure, however, should be avoided in the tight upper lip because of a great deal of tension on the donor.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.1
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• pp.47-61
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• 2004

The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in bilateral cleft lip and palate (BCLP) patients are challenging for both orthodontists and oromaxillofacial surgeons. It is due to the difficulty in achieving complete closure by using local attached gingiva (palatal flap) and the great volume of bone required for the graft. In this article, the authors used bifocal distraction-compression osteosynthesis(BDCO) to create a segment of new alveolar bone and attached gingiva for the complete approximation of a wide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveolar defect. Since the alveoli and gingivae on both ends of the cleft were approximated after BDCO, the need for extensive alveolar bone grafting was eliminated. It also could create new alveolar bone and gingiva for orthodontic tooth movement and implant.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.197-200
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• 2008

Purpose: A congenital lacrimal sac fistula is unusual and consists of a dimple opening below the medial canthal tendon that leads to the lacrimal sac. This anlage ducts occur when the lacrimal anlage cells proliferate and canalize rather than involute. And, the anomaly is usually not associated with any systemic abnormalities. Also congenital cleft of the earlobes is rarely seen among congenital ear anomalies. Therefore, we report rare case with symptomatic bilateral lacrimal fistula with the ear cleft. Methods: A 4-year-old boy was admitted with aggravated chronic maxillary sinusitis, recurrent chronic dacryocystitis, and epiphora. He had two minor anomalies including bilateral lacrimal fistula originated in lacrimal tear sac and unilateral transverse ear cleft. The patient had been operated with fistulectomy and perioperative antibiotics. A small vertical ellipse is made around the opening with sharp dissection. The tract is excised using the probe as the guide. Another probe is placed through the lower canaliculus to prevent the damage. A suture ligature of 6-0 Maxon is placed around the deepest point of the tract, which is then excised. Additional sutures are placed in the tissues to form a tight closure to prevent reestablishment of the fistula. The skin is closed with 6-0 Black Silk. Results: The patient recovered well without any complications such as infection, epiphora, and obstruction of lacrimal sac. Conclusion: Our case illustrates bilateral lacrimal anlage ducts in a patient with unilateral congenital ear cleft. We recommend careful evaluation of lacrimal system in these patients, especially bilateral case and other congenital anomalies. Finally, we recommend excision of the ducts when epiphora, infection, or chronic skin irritation occur.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.510-516
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• 2022

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter (p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater (p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.15-18
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• 2011

Purpose: The anterior iliac crest is a common source for autologous cancellous bone graft. For patients who have previously received cancellous bone grafts from bilateral anterior iliac crests, there may be concerns of whether a sufficient quantity of autologous cancellous bone remains for additional grafts without harvesting it from other sites, such as the posterior iliac crest. Methods: We experienced 3 cases of reharvesting in 2 patients. The diagnosis of the first patient was bilateral facial cleft number 3. This patient received bilateral side cleft alveoloplasty with corticocancellous bone graft from the both anterior iliac crest respectively by a previous surgeon. This patient then needed reharvesting of the anterior iliac crest cancellous bone to correct an ongoing skeletal problem for the bilateral cleft. The other patient had bilateral incomplete cleft of the primary palate. This patient received left side cleft alveoloplasty with cancellous bone graft from the right anterior iliac crest. Before the patient could receive the alveoloplasty on the other side, a radial head osteotomy and cancellous bone graft was performed by orthopedic surgeons who then used the remaining left iliac crest in order to treat a pulled elbow. For the completion of the right side cleft alveoplasty, the anterior iliac crest cancellous bone needed to be reharvested. Prior to the reharvesting, a preoperative computed tomography scan of the pelvis was obtained to assess the maturity of the donor site regeneration. The grafts were then taken from site where a greater amount of regeneration was evident. Results: Long term follow ups showed that the grafts were successfully taken. This sufficient volume was obtainable 14 months after the first harvest. Conclusion: Satisfactory results were achieved after the reharvesting of iliac cancellous bone. Thus, it appears that the reharvesting of the iliac bone is a possible alternative to multiple site grafting, use of allograft or bone substitute materials.

• The korean journal of orthodontics
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• v.50 no.6
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• pp.383-390
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• 2020

Objective: To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). Methods: The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998-2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using non-parametric statistical analysis. Results: The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. Conclusions: Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.88-91
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• 2011

Our case presents unusual case of Bilateral second brachial cleft fistulas The brachiogenic anomalies usually arise from an imcomplete obliteration of branchial appartus are common congenital cervical anomalies. But Bilateral manifestation are very rare. We treated it with surgical excision and it has not occurred recurrence until now. So we report about its character and treatment of Bilateral second brachial cleft fistulas.

• Proceedings of The Korean Cleft Lip And Palate Association
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• 2002.02a
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• pp.41-48
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• 2002

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.353-360
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• 2009

The principles for repair of bilateral cleft lip and nasal deformity are 1) symmetry, 2) primary muscular continuity, 3) proper philtral size and shape, 4) formation of the median tubercle and vermilion-cutaneous ridge from lateral labial elements, and 5) primary positioning of the alar cartilages to construct the nasal tip and columella. The authors underscore the essential role of preoperative premaxillary positioning for the synchronous closure of the cleft lip and primary palate, and describe Mulliken's operative technique. We discuss three-dimensional adjustments based on predicted fourth-dimensional changes. In a consecutive series of 50 patients, no revisions were necessary for philtral size or columellar length. Preoperative premaxillary positioning and primary repair of bilateral cleft lip and nasal deformity may impair maxillary growth. Nevertheless, a symmetric nasolabial appearance, rather than emphasis on maxillary growth, is the priority for the child with bilateral cleft lip.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.64-68
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• 2020

The coexistence of craniofacial cleft and bilateral choanal atresia has only been reported in three cases in the literature, and only one of those cases involved a Tessier number 3 facial cleft. It is also rare for bilateral choanal atresia to be found in adulthood, with 10 previous cases reported in the literature. This report presents the case of a 19-year-old woman with a Tessier number 3 facial cleft who was diagnosed with bilateral choanal atresia in adulthood. At first, the diagnosis of bilateral choanal atresia was missed and septoplasty was performed. After septoplasty, the patient's symptoms did not improve, and an endoscopic examination revealed previously unnoticed bilateral choanal atresia. Computed tomography showed left membranous atresia and right bony atresia. The patient underwent an operation for opening and widening of the left choana with an image-guided navigation system (IGNS), which enabled accurate localization of the lesion while ensuring patient safety. Postoperatively, the patient became able to engage in nasal breathing and reported that it was easier for her to breathe, and there were no signs of restenosis at a 26-month follow-up. The patient was successfully treated with an IGNS.