• 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.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.2
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• pp.65-72
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• 2009

Quadrilateral flap technique for primary cheiloplasty in patients with cleft lip was initially developed by Hagedorn in 1884. After Le Mesurier presented this procedure in 1940's, many surgeons adopted this technique for clinical advantage of reconstruction of Cupid's bow and lesser amount of tissue discarding than straight line technique. However, owing to its drawbacks such as sacrifice of Cupid's bow and prominent scar on philtral ridge, other techniques like Tennison's triangular flap and Millard's rotation-advancement flap have gradually taken its place. Nevertheless, some clinicians like Dr. Wang has modified this quadrilateral flap technique for better clinical outcomes. In this report we present 3 cases of unilateral complete cleft lip patients who underwent primary cheiloplasty with favorable outcomes based on Dr. Wang's modified quadrilateral flap technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.3
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• pp.200-204
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• 2012

In the repair of unilateral complete cleft lip, the most popular method is the rotation-advancement by Millard. Despite advantages of Millard repair, a few pitfalls exist. Above all, some of the scars, at the height of the cleft side philtral ridge, cross the Langer's line. Further, in the repair of complete cleft lip, small triangular lateral lip flap is often added in the base of an advancement flap to level the Cupid's bow. Moreover, preservation of the advancement flap has some negative effects on a primary nasal repair. As a result, the shape of philtrum is somewhat unnatural. Therefore, I applied the extended Mohler repair in the six cases of complete wide cleft lip to get a more esthetic scar. As a result, more natural, straight philtral ridge was obtained, without adding small triangular flap in the base of the advancement flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.348-355
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• 2006

Tennison was the first to recognize and to preserve the Cupid's bow by lowering the peak in the margin of the cleft. Randall had modified the Tennison's repair based on accurate measurements. Bardach's technique evolved from the basic concept of triangular flap cleft lip repair described by Tennison-Randall method. Precise measurements are used to define the dimensions of the equilateral triangular flap, which is created on the cleft side and is inserted into an equilateral triangular defect on the noncleft side. Two symmetrical vertical distances on either side of the cleft are thus formed. It is essential that the incisions in the skin correspond precisely with those on the muscles and mucosa, and that all layers are sutured with the use of the triangular flap, thus preventing vertical scar contracture. This procedure produces a symmetric, balance lip with a well-defined Cupid's bow, a symmetric vermilion, and a properly aligned orbicularis oris muscle. We had treated three patients with unilateral incomplete cleft lip by using Bardach's triangular flap method. The operation scars could be reduced comparing to Millard method because Bardach's method did not use the columella base and the alar base incision. And the flap design was more simple and accurate comparing to Tennison-Randall method. On the other hand, the postoperative scars on the philtrum pointed as a disadvantage of triangular flap method were cosmetically acceptable because the three patients had incomplete cleft lip. We have experienced that Bardach's triangular flap is a recommendable technique for the repair of unilateral incomplete cleft lip.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.55-62
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• 2007

Radical paring of the cleft edge during primary cleft lip operation or repeated secondary surgeries can result in tightness of the upper lip. In case, the degree of the resulting side-to-side tension is very severe, the possibility of a lip switch flap must be considered. When the lip tightness accompanies a loss of more than two-thirds of the Cupid's bow, an Abbe flap is an alternative. The disadvantages of Abbe flap are scar formation on the lower lip, design of incision line on the upper lip, disharmony of colors, and the dysfunction of the orbicularis muscle. These problems have been recognized in the literature and extreme discretion has been advised in its application. We experienced four cases of Abbe flap operation which were designed differently to correct the secondary unilateral or bilateral cleft-lip nasal deformities. The Abbe flap operations resulted in removal of the scars and tightness of the upper lip, reconstruction of the Cupid's bow, lengthening of the columella, and therefore secondary cleft-lip nasal deformity could be corrected. It is thought that carefully applied Abbe flap is an appropriate method to relieve horizontal tightness or flattening of the upper lip which occured after primary operation of cleft lip.

• Journal of the Korea Institute of Military Science and Technology
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• v.21 no.1
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• pp.10-16
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• 2018

The Republic of Korea Marine Corps is planning to develop a new amphibious assault vehicle which is able to operate with higher water speed than current KAAV. In order to achieve a higher water speed for hydrodynamically bulff-body vehicles, it is essential to develop drag reduction strategies. In this paper, resistance characteristics including trim angles of amphibious assault vehicles with several appendage designs are investigated using a commercial CFD code, STAR-CCM+. The computed results are compared with experimental data conducted at the towing tank with 1:4.5 scaled model and show good correlation. Comparing with the results of bare hull, 3.4 % of hydrodynamic drag and 52 % of trim angle are reduced by the application of double angled bow flap and a hydrofoil attached at the transom.

• Korean Journal of Cleft Lip And Palate
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• v.10 no.2
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• pp.67-74
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• 2007

After Tennison introduced a triangular flap method which, for the first time, preserved the Cupid's bow, Randall gave this method a sound mathematical basis. This method is also called as an inferior triangular cheiloplasty which is characterized by making a small triangular flap from the lateral border of cleft destined to be fitted into an incision on the medial side of cleft. He postulated that the height obtained was equal to the sum of the median of the two triangles used in the cheiloplasty. Using this technique, a 22 month-old male patient with incomplete unilateral cleft lip was corrected primarily. The deviation of the columella and flattening of the nostril on the cleft side were minimal. The operation was done under general anesthesia and patient was healed uneventfully. We tried to improve the symmetry and esthetic feature of philtrum, nostril sill, alar-facial groove, preventing the notch formation on the nostril floor, and to reconstruct the muscle sling in the upper part of lip. The shape of Cupid's bow was restored, and the symmetry of columella was regained as a result. In summary, the inferior triangular cheiloplasty is effective to correct the primary unilateral cleft lip, results in the restoration of favorable anatomy and function.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.12.1-12.5
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• 2017

Background: Rehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisher introduced an innovative method, named "an anatomical subunit approximation technique" in unilateral cleft lip repair. According to this method, circumferential incision along the columella on cleft side of the medial flap is continued to the planned top of the Cupid's bow in straight manner, which runs parallel to the unaffected philtral ridge. Usually, small inlet incision is needed to lengthen the medial flap. On lateral flap, small triangle just above the cutaneous roll is used to prevent unesthetic shortening of upper lip. This allows better continuity of the Cupid's bow and ideal distribution of tension. Case presentation: As a modification to original method, orbicularis oris muscle overlapping suture is applied to make the elevated philtral ridge. Concomitant primary rhinoplasty also results in good esthetic outcome with symmetric nostrils and correction of alar web. As satisfactory results were obtained in three incomplete and one complete unilateral cleft lip patients, indicating Fisher's method can be useful in cleft lip surgery with functional and esthetic outcome. Conclusions: Clinically applied Fisher's method in unilateral cleft lip patients proved the effectiveness in improving the esthetic results with good symmetry. This method also applied with primary rhinoplasty.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.2
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• pp.154-157
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• 2011

The primary purpose of cleft lip surgery should be the aesthetic and functional recovery of the facial components. Triangular flap repair is one of the most common techniques used in cleft lip surgery. In this case report, thirty patients with unilateral cleft lip had been treated using the Tennison-Randall method. The results were favorable and there have been no permanent complications.