• 대한두개안면성형외과학회지
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• 제11권1호
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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.

• 대한두개안면성형외과학회지
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• 제19권1호
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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.

• 대한구순구개열학회지
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• 제12권2호
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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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• 제34권3호
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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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• 제28권4호
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• pp.348-355
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• 2006

우리는 3예의 편측성 불완전 구순열 환아에서 Bardach 삼각피판법을 사용하여 구순열을 수복하였다. Millard법에 비해 비주기저부와 비익기저부에 부가적인 절개를 가하지 않으므로 술후 반흔을 줄일 수 있었다. 또한 Tennison-Randall법에 비해 간단하면서도 정교한 계측에 의한 작도가 가능하였다. 한편 삼각피판법의 단점으로 지적되고 있는 인중 부위의 술후 반흔은 3예 모두 불완전 구순열이었기 때문에 삼각피판의 길이가 짧아 심미적으로 허용할 만하였다. Bardach 삼각피판법은 편측성 불완전 구순열의 수복에 추천할 만한 술식임을 경험하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권1호
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• pp.55-62
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• 2007

구순열의 일차 수술 또는 이차 수술 후에 발생하는 상순의 지나친 긴장은 상하순 간의 부조화, 상악열성장, 골격성 III급 부정교합 등 안모추형을 초래한다. 상순의 긴장이 매우 심한 경우에는 하순의 여유 있는 조직을 이용하여 상순을 수정하는 Abbe 피판을 고려할 수 있다. 상순의 긴장이 큐피드궁의 2/3 이상의 조직 손실을 동반할 경우 Abbe 피판의 적응증이 된다. Abbe 피판은 상순과 하순의 반흔, 색상의 부조화, 그리고 상순의 불완전한 운동을 초래하는 단점을 가진다. 그러므로 Abbe 피판은 신중하게 사용되어야 한다. 우리는 편측성 구순열 1예와 양측성 구순열 3예에서 상순의 과도한 긴장과 큐피드궁의 조직 결핍 그리고 비변형이 심한 이차성 구순열비변형을 교정하기 위해 세 가지 형태의 Abbe 피판을 이용한 이차 교정술을 경험하였다. Abbe 피판수술을 시행한 결과 상순의 반흔과 긴장이 해소되고 큐피드궁이 재건되고 비주의 길이가 증가되어 이차 구순열비변형을 교정할 수 있었다. Abbe 피판은 신중을 기해 적용한다면 구순열 수술 후에 발생되는 상순의 수평적 긴장감이나 편평함을 해결하는 데 유용한 술식임을 알 수 있었다.

• 한국군사과학기술학회지
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• 제21권1호
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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.

• 대한구순구개열학회지
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• 제10권2호
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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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• 제39권
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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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• 제33권2호
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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.