• Archives of Plastic Surgery
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• 제33권4호
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• pp.399-406
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• 2006

Purpose: The authors accessed the anthropometric measurements of fourty non-cleft normal a three-month-old infant and using this obtained data as a basic guideline, authors applied the modified Noordhoff technique for the treatment of bilateral cleft lip. Methods: Over a period of 10 years, a total of 21 bilateral cleft lips were operated. 13 cases of complete and 8 cases of incomplete bilateral cleft lip and palate. In the complete type of bilateral cleft palate, elastic head cap and passive intraoral appliance were applied at 1 to 2 week of age for 2 months duration. The definitive cheiloplasty was performed at 3 months of age using the modified Noordhoff technique. Results: After a follow-up period ranging one to nine years, most patients presented with cosmetically and functionally satisfying results, with an exception of two cases where an undesired peaking effect of the vermilion and dimpling of the vermilion mucosa was encountered. Conclusion: Accessing the anthropometric measurements of fourty non-cleft normal three-month-old infant and using this obtained dara as a guideline, the modified Noordhoff technique can be applied to either complete or incomplete bilaterally cleft lip providing more naturally pleasing and cosmetically satisfying scars that lie in harmony with the philtral ridges, lip tubercle positioned just below the vermilion and a distinct white line and Cupid's bow.

• 대한구순구개열학회지
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• 제7권1호
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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.

• 대한구순구개열학회지
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• 제4권2호
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• pp.51-68
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• 2001

Midfacial hypoplasia in patients with clefts of the lip and palate is considered to be the result of congenital dysmorphogenesis. And cleft lip and palate developes facial deformity, jaw abnormality, speech problem, which is most frequent hereditary deformity in maxillofacial region. So cleft lip and palate is characterized by midface deformity which shaws maxillary anterior nasal septal deviation and deformity. Our study describes congenital correlates of midfacial hypoplasia by examining the displacement of a normal complement of parts, a triangular tissue deficiency low on the lip border on the columellar side, and a linear deficiency and displacement in the line of the bilateral cleft lip. 15 patients with bilateral cleft lip and palate were taken impression before operation, but the patient who had other abnormalities and complications were excluded. Average age is 3.4 months and they were classified into both complete, both incomplete and complete & incomplete group. The obtained results were as follows 1. There were no differences on intercanthal width and canthal width between each of the groups. 2. Both complete group had longer lateral ala length than both incomplete group, but there were no differences between both complete group and complete side of com. & incom. group and both incomplete group and incomplete side of com. & incom. group. 3. Columella length was greater in both incomplete group than in both complete group, but there was no difference between both complete group and complete side of com. & incom. group and both incomplete group and incomplete side of com. & incom. group. 4. Both complete group had longer ala width & ala base width than both incomplete group had. But there were no differences between both complete group and complete side of com. & incom. group and both incomplete group and incomplete side of com. & incom. group. 5. There were no differences between each of the groups on upper lip length, but nose/mouth width ratio was greater in both complete group than in both incomplete group. 6. Pronasale(pm), subnasle(sn), la~rale superioris(ls), stomion(sto) points were located around the central vertical line of face but deviated to incomplete side in com. & incom. group. 7. Nasal tip protrusion was greater in both incomplete group and com. & incom. group than both complete group, but there was no difference between both incomplete group and com. & incom. group.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.518-524
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• 2019

Background Anterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft. Methods A retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty. Results In total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes. Conclusions Anterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 1997년도 종합학술대회
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• pp.57-57
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• 1997

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권4호
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• pp.295-309
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• 2006

The present study was aimed to evaluate the incidence, etiological factors, and management of cleft lip and palate. Two hundred and twenty patients with cleft lip and/or cleft palate who were treated at Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, during the period between January 1994 and December 2003 were reviewed. The ratios of cleft lip : cleft lip with cleft palate : and cleft palate were 0.4:1.1:1. Males were more common than females in cleft lip (1.3:1) and cleft lip and palate (2.5:1), while females were more common than males in cleft palate (1:1.3). In the cleft side, left clefts were more prevalent than right clefts (cleft lip 1.3:1, cleft lip and palate 1.6:1). Unilateral clefts were more common than bilateral clefts in cleft lip (79:21). Cleft lip and cleft palate were more common in those with blood type A (34.5%) than those with other types. There was no significant relationship between birth season and frequency of clefts. The clefts were common in the first-born (48.8%), and in mothers aged between 25 and 29 (51.7%). Medication (24.7%) and stress (16.7%) during the first trimester were noted. Positive familial history was noted in 13 cases (5.9%). Thirty-two cases (15%) were associated with other congenital anomalies, in which tonguetie (40.6%) and congenital heart disease (21.9%) were most common. Among 100 patients with cleft palate, 77 patients had middle ear disease (77%), which occurred predominently in the incomplete cleft palate. Seventy-six among the 77 patients received myringotomy and ventilation tube insertion, and the remaining one received antibiotic medication only. Cleft lips were treated primarily at 3 to 6 months, and cleft palates were at 1 to 2 years. Treatment regimens included modified Millard method mainly in the cleft lip, and Wardill V-Y, Dorrance method, and Furlow method in the cleft palate. The percentage of palatal lengthening as type of cleft palate was greater in the incomplete cleft palate group (11.2%) than in the complete cleft palate group (9.6%). The percentage of palatal lengthening as operating method was no difference between the Furlow method (10.9%) and the push back method (10.7%). As postoperative complications, hypertrophic scar was most frequent in the cleft lip, and oronasal fistula in the cleft palate. In summary, it was shown that medication and stress during the first trimester of pregnancy were frequently associated with cleft lip and cleft palate, adequate timing and selection of method of operation are important factors to obtain morphologically and functionally good results. Furthermore prevention and treatment of middle ear disease are important in cleft palate patients because of its high co-occurrence.

• 대한구순구개열학회지
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• 제12권2호
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• pp.57-64
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• 2009

전방으로 심하게 돌출된 전상악골로 인하여 구순성형술 및 비성형술의 결과가 악화 될 수 있다. 따라서 변위된 전상악골의 이상적인 위치로 재위치 시키려는 다양한 노력이 시도되어 왔다. 에디오피아와 같은 개발도상국에서는 어른이 되어서도 수술을 받지 못하는 구순구개열 환자가 많이 있다. 성인이 될 때까지 수술받지 못한 양측성 완전 구순구개열 환자에서는 근육, 골, 피부, 점막의 연속성이 없어서 전상악골이 심하게 전방으로 혹은 하방, 좌우측으로 변위된 경우가 대부분이다. 이 경우 구순성형술이 거의 불가능하며, 시도된다 할지라도 돌출된 전상악골 때문에 양쪽 구륜근을 봉합하여 주기가 대단히 어렵다. 따라서 이상적인 결과를 얻기 위해서는 구순성형술 전 혹은 동시에 전상악골의 재위치 술식이 필수적이다. 저자는 한국국제협력단에서 국제협력의사로 선발되어 에디오피아에서 30 개월간 근무하였다. 그 동안 다양한 양측성 완전 구순구개열 환자에서 전상악골의 재위치 술식을 경험하였다. 저자가 경험한 전상악골의 재위치 술식(전상악골의 재위치와 골이식술 동시 시행, 전상악골의 재위치와 구개열 성형술 동시시행)에 대하여 문헌고찰과 함께 보고하고자 한다.

• 대한소아치과학회지
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• 제23권3호
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• pp.729-735
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• 1996

Cleft lip and palate is the most common malformation in the craniofacial region. The patients with cleft lip and palate have functional problem such as, speech, feeding and respiratory as well as esthetic problem. So, treatment should be done by multidiciplinary team approach. The role of pediatric dentist in the team is advicement for feeding method, guidance of normal growth, caries control and preventive orthodontics. In cleft lip and palate patients, maxillary arch after cheiloplasty is usually collapsed by excessive tension of the scar. This collapse increase the difficulty of later orthodontic treatment. Therefore, the maxillary arch segments should be moved and retaind to normal position as soon as cheiloplasty is done to reduce the need and difficulty of orthodontic treatment. This concept is called by the early orthopedic treatment in cleft lip and palate. Also, this orthopedic appliance works as feeding applince to normal feeding and weight gain We reported two cases of early orthopedic treatment with favorable result in complete bilateral cleft lip and palate patients after cheiloplasty. Patients showed normal weight and their maxillary arch widths were increased.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.35.1-35.7
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• 2015

After cleft lip repair, many patients suffer from nasolabial fistulas, asymmetrical nasal floor, or an indistinct nostril sill, as well as intraoral wound dehiscence and subsequent scar contracture of surgical wounds leading to vestibular stenosis. For successful primary nasolabial repair of complete cleft deformity of the primary palate, cleft surgeons need special care in reconstructing the sound nasal floor. Especially when the cleft gap is wide or when any type of nasoalveolar molding therapy was not performed, three-dimensional reconstruction of the nasal floor is critical for a balanced nasal shape. In this study, the author describes an effective method for reconstructing a double-layered nasal floor using two mucosal flaps from both sides of the fissured upper lip. This is a report of six patients with unilateral or bilateral complete cleft of the primary palate with a detailed description of the surgical technique and a literature review.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.5.1-5.5
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• 2019

Background: The present study aimed to determine whether laypeople and professionals rate the facial appearance of individuals with repaired complete unilateral or bilateral cleft lip and palate (UCLP, BCLP) similarly based on viewing full facial images. Methods: The study followed a cross-sectional analytical design where five young patients aged 10 to 14 years, who had completed all stages of their unilateral or bilateral cleft lip and palate treatment (bilateral: three, unilateral: two), were evaluated by two groups. The assessment was done by laypeople and 97 qualified professionals (33 orthodontists, 32 plastic surgeons, and 32 oral and maxillofacial surgeons). Professionals were not involved in any stage of the patients' treatment. Results: The facial appearance assessment of the professional groups on different facial aesthetics was significantly lower than that of laypeople, and they had higher perceived need for further treatment. On the other hand, laypeople had higher aesthetic ratings and lower perceived need for further treatment. Differences were also observed between the assessments of the professional groups. Participants who had lower aesthetic assessments of the repair tended to report a higher influence of cleft lip and palate on social activities and professional life. Conclusion: Differences in perception exist between healthcare professionals and laypeople. The discrepancies between the professional groups could be attributed to different treatment modalities and protocols.