• The korean journal of orthodontics
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• v.22 no.3 s.38
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• pp.657-673
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• 1992

Orthodontic treatment of cleft patients is difficult as the growth is different from that of normal ones. So it is very important to know the characteristic features of the craniofacial morphology and growth pattern in unilateral cleft lip and palate patients. The materials for this study consisted of 55 normal males and 50 unilateral cleft lip and palate ones who received cheiloplasty and palatoplasty previously. The cleft subjects were divided into 4 groups according to their ages kto find out the growth pattern of hard and soft tissue, and to compare the features with those of normal ones. Each cephalogram analysed by McNamara method and others. The obtained results were as follows 1. In the unilateral cleft lip and palate subjects, forward growth of the maxilla was smaller than that of normal ones from 9 years old. So the maxilla was retruded. The maxillary incisors were severely retruded in all age groups. 2. The mandibular overall length and its anteroposterior position did not show any significant differences between two groups. But the height of ramus was very short and the mandible had vertical growth tendency to compensate for undergrowth of the maxilla in cleft subjects after 12 years of age. 3. Horizontal growth of the soft tissue in middle face was smaller than that of any other facial region from 9 years old. The vertical growth rate of upper lip was decreased as growing old. 4. In cleft subjects, the upper and lower facial component angle and the facial convexity angle were large. So their facial profile changed to straight or concave as growing old.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.563-569
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• 2006

Purpose: In the correction of cleft lip, there have been various methods to minimize recurrence of the nasal deformity after primary nasal surgery. After cheiloplasty and primary nasal surgery, we tried to elongate the columella of the cleft side, to stretch the vestibular lining of cleft side, and to elevate the alar cartilage of the cleft side with a molding prong. Methods: We had fifteen cleft lip patients; 12 unilateral cases(6.3-8.2 months), and 3 bilateral cases(3 - 7.5 months). Immediately after primary repair of the cleft lip, the toboggan shaped molding prong was located to deep inside of vestibular web of the cleft side. It was persistently suspended by a silicone tube which was connected to the prong and the frontal scalp. The results were analyzed with $Photoshop^{(R)}$ photogrammetrically for 6 - 48 months with on average of 20.6 months. We measured the proportion index of columellar length-interalar distance for three times(preoperation, immediate postoperation, and postoperation) on the nasal base views. Results: In unilateral, the index had a significant increase statistically between preoperation(10.73) and immediate postoperation(23.96). It is supposed that columellar length was reconstructed to 105.80% of normal side. But, it was decreased to maintain 87.7% of normal side in postoperation(20.54). The results were similar in bilateral. The linear scars by suture penetrating nose skin were not discernable. Conclusion: In summary, placement of the molding prong could elongate the reconstructed columella with some relapse postoperatively.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.2
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• pp.93-106
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• 2004

본 연구의 목적은 편측성 구순구개열 (UCLP) 환자에서 술전 비치조 정형장치 (presurgical nasoalveolar molding appliance, PNAM) 와 구순 봉합수술의 치조골 정형효과를 3차원 (3-D) 분석을 통하여 평가하는 것이다. 연구대상은 16명의 UCLP 환자 (평균 파열부거리: 10.46mm) 이며 PNAM 장치에 의한 치료와 rotation-advancement법에 의한 구순 봉합수술을 받았다 처음 내원시 (평균연령: $37.0{\pm}27.89$ 일), PNAM 치료를 받고 난 후이며 구순봉합수술 1달 전 (평균연령: $119.25{\pm}40.18$ 일), 구순봉합수술 2달 후 (평균연령: $190.81{\pm}42.78$ 일)에 상악의 인상을 채득하였다. 그 후 laser scanning machine (Orapix, Dimennex, Seoul, Korea) 과 3-D view software (3Dxer, Dimennex) 를 사용하여 3-D모형을 제작하였다. 선, 각도, 정중선변이, 거리, 면적 항목을 3-D 모형상에서 계측하고, 각 시기별의 차이를 비교하기 위하여 Wilcoxon signed rank test를 사용하여 분석하였다. PNAM치료 동안과 구순 봉합수술 후에도 치조골 후방부는 안정된 구조물이었다. PNAM치료에 의한 파열부 거리의 감소는 대분절 (greater segment) 의 내측 굴곡 (bending) 에 의하여 발생하였다. 대분절 (greater segment)의 전방 성장은 PNAM치료에 의하여 억제되었으나, 구순 봉합수술 후에 회복되었다. 구순 봉합수술 후에 대분절과 소분절 사이의 전방부 각도의 증가는 구순 반흔 (lip scar) 의 압력에 의한 치조골 정형 효과 때문으로 생각된다. 정중선변이는 PNAM치료에 의하여 개선되었다. PNAM치료 동안과 구순 봉합수술 후에 구개부 (palatal segment) 의 면적은 계속 증가하였다. 치조골 면적과 거리 항목의 증가는 후방부에서 크게 나타났다. 이러한 결과는 PNAM치료에 의한 치조골 정형효과는 주로 전방부에서 발생하며, 치조골의 성장은 구순 봉합수술 후에 후방부에서 주로 발생한다는 것을 의미한다.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.2
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• pp.69-82
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• 2012

Our Team Approach consists of following five stages; (1) Peri-natal care until lip repair After ultrasound diagnosis, some obstetricians recommend the mother with CL/P fetus to undergo prenatal counseling in our CLP clinic. On the day the CL/P baby was born, our oral surgeon, nurse, and pedodontist visit the maternity clinic, and take counseling and take impression for a feeding plate. The cheiloplasty is performed in three months old. (2) From lip repair to palatal repair At one year of age, Otorhinolaryngologist checks middle-ear disease. Palatoplasty is carried out at 1.5 - 2 years old. (3) In deciduous and early mixed dentitions Speech is the most important issue in social life for the CL/P subjects, therefore the training of velopharyngeal function is essential. Orthodontist monitors dentofacial development from 5 years of age. In the case of severe maxillary under-growth or severe collapse, maxillary protractor or lateral expansion is indicative, respectively. In early mixed dentition, upper central incisor on the cleft area erupts with some torsion, and then the traumatic occlusion with tooth torsion must be corrected. (4) In mixed dentition Right before the eruption of upper canines, secondary bone grafting is performed. One year prior to the operation, maxillary fan-type expansion is carried out to correct the collapse of maxillary segments. Following the surgical operation, the erupted canine will be moved into the transplanted bone to avoid alveolar resorption. (5) In permanent dentition Final tooth alignment is carried out after eruption of second molars. Some cases may require orthognathic surgery after physical maturation. Prosthetic oral rehabilitation including the dental-implant is carried out after age eighteen.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.1
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• pp.21-32
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• 2009

Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.485-489
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• 2011

Purpose: Median cleft of upper lip is defined as any congenital vertical cleft through the midline of the upper lip. It is uncommon, its embryological pathogenesis remains unexplained to date. The authors hereby report a rare case of median cleft of the upper lip associated with enlarged frenulum and palatal mass. This case offers some understanding of the possible embryologic development of this anomaly. Methods: A 10-month-old boy born by normal vaginal delivery at full-term had a notch in the midline of the upper lip with widened philtrum along with enlarged median frenulum, alveolar cleft, and mass of the hard palate. We performed en bloc resection of the enlarged frenulum and palatal mass and cheiloplasty under general anesthesia. Results: Histological examination revealed that the frenulum and palatal mass was consisted of fibrous tissue with normal mucous membrane. The postoperative course was satisfactory. Conclusion: A rare case of median cleft of the upper lip with associated enlarged frenulum and palatal mass was presented with proper surgical management. The surgical technique includes marginal excision of the clefted epithelium and reconstruction of orbicularis oris muscle, in addition to en bloc resection of the palatal mass and frenulotomy.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.85-92
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• 2021

Background: Patients with secondary deformities associated with unilateral cleft lip and nose might also suffer from nostril stenosis due to a lack of tissue volume in the nostril on the cleft side. Here, we used full-thickness skin grafts (FTSGs) to reduce nostril stenosis and various methods for skin volume augmentation. We compared the changes in the symmetry of both nostrils before and after surgery. Methods: From February 2016 to January 2020, 34 patients underwent secondary cheiloplasty and open rhinoplasty for secondary deformities of the unilateral cleft lip and nose with nostril stenosis. FTSG was used on the nostril floor, nasal columella, and alar inner lining. The measured nasal profile included the nostril surface, nostril circumference, width of the nostril floor, and distance from the alar-facial groove to the nasal tip. The "overlap area," which was defined as the largest overlapping area when the image of the cleft nostril was flipped to the left and right and overlaid on the image of the normal side nostril, was also calculated. The degree of symmetry was evaluated by dividing the value of the cleft side by that of the normal side of each measured profile and expressed as "ratios." Results: The results of all profile ratios, except for the nostril floor width, became significantly close to 1, which represents full symmetry. The overlap area ratio improved from 62.7% to 77.3%, meaning that the length and width of the nostril as well as the overall shape became similar (p< 0.05). Conclusion: When performing cleft rhinoplasty with nostril stenosis, FTSG is useful to achieve symmetry in the nostril size and shape. Skin grafting is simpler to perform than the other types of local flap, and the results are generally satisfactory.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.256-262
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• 1998

The aim of this study was to evaluate treatment plan and treatment procedure such as bone graft material, timing of bone graft and orthodontic treatment in 31 alveolar cleft bone graft patients treated at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from Jan. 1992 to Dec. 1996. Results obtained were as follows : In total 31 patients of alveolar bone grafts, males(64.5%) were more than females(35.5%). The patients' age ranged between 2 - 33 years of age. Secondary bone grafting was the highest incidence(58.1%) when procedures were undertaken in patients between 6 - 16 years of age. In distribution of cleft side, unilateral clefts(93.5%) were the major part with the left side was larger than the right side. The Missing teeth were found most in lateral incisor, the supernumary teeth were found most between lateral incisor and canine. The most common occlusion before operation was class III malocclusion and anterior cross-bite(65.1%), orthodontic treatment was performed similarly between before and after the bone graft. The most common combined operation with alveolar bone graft was secondary cheiloplasty. The complications were 6 cases of bone defect, a case of oronasal fistula, 3 cases of dehiscence. PMCB and DFDB were used bone graft materials. In marginal bone height after operation, PMCB grafts were higher than DFDB grafts and marginal bone level was increased in the PMCB group but not in the DFDB group.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.430-435
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• 2000

Cleft lip and palate is one of the congenital anomalies which need comprehensive and multidisciplinary treatment plan because 1) oral cavity is an important organ with masticatory function as a start of digestive tract, 2) anatomic symmetry and balance is esthetically important in midfacial area, and 3) it is also important to prevent psycho-social problems by adequate restoration of normal facial appearance. There are many different protocols in the treatment of cleft lip and palate, but our department has adopted and modified the $Z{\"{u}}rich$ protocol, as published in the Journal of Korean Cleft Lip and Palate Association in 1998. The first challenge is feeding. Type of feeding aid ranges from simple obturators to active orthopedic appliances. In our department we use passive-type plate made up of soft and hard acrylic resin which permits normal maxillary growth. We use Millard's method to restore normal appearance and function of unilateral complete cleft lip. In consideration of both maxillary growth and phonetic problems, we first close soft palate at 18 months of age and delay the hard palate palatoplasty until 4 to 5 years of age. When soft palate is closed, posterior third of the hard palate is intentionally not denuded to allow normal maxillary growth. In hard palate palatoplasty the mucoperiosteum of affected site is not mobilized to permit residual growth of the maxilla. We have treated a patient with unilateral complete cleft lip and palate by Ajou protocol, which is a kind of modified $Z{\"{u}}rich$ protocol. It is as follows: Infantile orthopedics with passive-type plate such as Hotz plate, cheiloplasty with Millard's rotation-advancement flap, and two stage palatoplasty. It is followed by orthodontic treatment and secondary osteoplasty to augment cleft alveolus, orthognathic surgery, and finally rehabilitation with conventional prosthodontic treatment or implant installation. The result was good up to now, but we are later to investigate the final result with longitudinal follow-up study according to master plan by Ajou protocol.