• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.53-60
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• 2009

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgical-orthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow-up the result was retained well.

• The korean journal of orthodontics
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• v.51 no.1
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• pp.43-54
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• 2021

Objective: To investigate the cephalometric predictors of the future need for orthognathic surgery in Korean patients with unilateral cleft lip and palate (UCLP) despite long-term use of facemask with miniplate (FMMP). Methods: The sample consisted of 53 UCLP patients treated by a single orthodontist using an identical protocol. Lateral cephalograms were taken before commencement of FMMP therapy (T0; mean age, 10.45 years), after FMMP therapy (T1; mean age, 14.72 years), and at follow-up (T2; mean age, 18.68 years). Twenty-eight cephalometric variables were measured. At T2 stage, the subjects were divided into FMMP-Nonsurgery (n = 33, 62.3%) and FMMP-Surgery (n = 20, 37.7%) groups according to cephalometric criteria (point A-nasion-point B [ANB] < -3°; Wits-appraisal < -5 mm; and Harvold unit difference [HUD] > 34 mm for FMMP-Surgery group). Statistical analyses including discrimination analysis were performed. Results: In FMMP-Surgery group, the forward position of the mandible at T0 stage was maintained throughout the whole stages and Class III relationship worsened with significant growth of the mandibular body and ramus and counterclockwise rotation of the maxilla and mandible at the T1 and T2 stages. Six cephalometric variables at T0 stage including ANB, anteroposterior dysplasia indicator, Wits-appraisal, mandibular body length, HUD, and overjet were selected as effective predictors of the future need for surgical intervention to correct sagittal skeletal discrepancies. Conclusions: Despite long-term use of FMMP therapy, 37.7% of UCLP patients became candidates for orthognathic surgery. Therefore, differential diagnosis is necessary to predict the future need for orthognathic surgery at early age.

• 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.

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.591-598
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• 2000

This study was designed to analysis the airway which affects to breathing, speech and facial growth pattern in unilateral cleft lip and palate patients. Upper airway and the position of hyoid bone pattern were analyzed on the lateral cephalometric radiographs of the 78 subjects of complete unilateral cleft lip and palate group and each group was divided two sub-groups by circumpubertal growth peak and gender. These data were statistically analyzed to examine the difference between pre-circumpubertal growth peak group and post-circumpubertal growth peak one, and between male and female group. The results of this study were as follows: 1. After circumpubertal growth peak stage, the position of hyoid bone was lower than before in both male and female group. 2. After circumpubertal growth peak stage, the measurement were increased in CV3ia-APH, PNS-ad which related to the volume of pharyngeal space. This was due to the decrease of adenoid and anteroiferior growth of mandible and affected to breathing and speech after circumpubertal growth peak. 3. During circumpubertal growth peak stage, all measurements increased more in male than female group, which due to the different amount of growth in different gender. 4. The position of hyoid bone was lower in male than female group in all age group. 5. After circumpubertal growth peak stage, CV3ia-APH increased more in male. This was due to the more growth in madible of male which resulted in the activation of digastric muscle.

• The korean journal of orthodontics
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• v.15 no.1
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• pp.105-114
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• 1985

In order to obtain the basic data of the movements of the mandible for orthodontic treatment and gnathosurgery of cleft individuals, the ranges and shapes of the movements of the mandible were measured in frontal, sagittal, and horizontal view with Saphon Visi-Trainer CII, in 19 adult cleft lip and palate individuals. The subjects included 5 BCLP, 9 UCLP, and 5 CLA patients. The measurements were compared with the values of normal individuals reported by Kang 1. Frontal view. The mean values for maximal laterotrusion were almost the same as those previously reported for the normal individuals. Mandibular deviation in maximal opening was usually toward the right, while it was mainly toward the left in normal individuals. Typical shield was formed only in the CLA group. 2. Sagittal view; The mean value for maximal protrusion was not different from that of normal group and antero-posterior deviation showed a significant difference. The angle of maximal protrusion and horizontal plane was less than that of normal group. 3. Horizontal view; The mean values for maximal laterotrusion and protrusion were not different from those of the normal group. The angle of the laterotrusion and horizontal plane was larger in the left and smaller in the right.

• Korean Journal of Cleft Lip And Palate
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• v.6 no.1
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• pp.35-42
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• 2003

PAP (Palatal Augmentation Prosthesis) may be given to the patients with dysphagia; especially, who cannot achieve tongue-palate contact. PAP fills hard palate area where the tongue cannot make contact and then the distance of tongue elevation is shortened. 1bat may be expected to improve swallowing and to prevent from aspiration. The purpose of this report is to show the effects of PAP in patients with dysphagia through the videofluoroscopic study. Oral-pharyngeal swallowing post PAP is analyzed in 2 cases; one is a person who had subarachnoid hemorrhage due to aneurysmal rupture, right hemiparesis, hydrocephalus and aphamia. And the other is a person who had squamous cell carcinoma on mouth floor and he had radical neck dissection and marginal mandibulectomy. In this report, the rate of aspiration, the transit time and length measurements of anatomical structure are examined in the each frame of videofluoroscopy. The results are as follows; 1) PAP decreased the aspiration in both cases. 2) In the cases of patients with PAP, the pharyngeal transit time was decreased.

• The korean journal of orthodontics
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• v.29 no.6 s.77
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• pp.649-661
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• 1999

The goals of this study were 1) to present pre-surgical naso-alveolar molding (PNAM) appliance for bilateral cleft lip and palate treatment and 2) to evaluate the effects of the PNAM appliance on the alveolar molding of the premaxilla and the lateral segments. Subjects consisted of 8 bilateral cleft lip and palate infants (7 males and 1 female, mean age at first visit = 61.6 days after birth) who were treated with PNAM appliances in Department of Orthodontics, Seoul National University Dental Hospital. Average alveolar cleft gap between the premaxilla and the lateral segment was $8.09{\pm}5.03mm$ and average duration of alveolar molding treatment was $8.8{\pm}3.1$ weeks. These patients' models were obtained at initial visit (T0) and after alveolar molding (T1). 20 linear and 14 angular variables were measured by using photometry and digital caliper, All statistical analyses were performed by Microsoft Excel 97 program. Paired t-test was used to discriminate the effect of alveolar molding by PNAM appliance. 1. Closure of the alveolar cleft gap in bilateral cleft cases by molding therapy was completed successfully, 2. Alveolar molding inhibited outward growth of lateral segments and produced inward bending of lateral segments. 3. By bending the anterior part of the vomer, the premaxilla could be rotated and moved. posteriorly via alveolar molding. Conclusion This appliance can be applied to bilateral cleft lip and palate infants with satisfactory results before cheiloplasty.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.16-22
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• 2019

Background Various surgical techniques have been used to correct Tessier number 7 craniofacial cleft, which involves macrostomia, ear deformity, and hemifacial microsomia. To achieve symmetrical and satisfactory results in patients with macrostomia, the authors performed a 1-mm medial overcorrection on the cleft side and evaluated the results of this procedure. Methods A retrospective medical record review of patients diagnosed with Tessier number 7 craniofacial cleft from March 1999 to February 2017 was performed. Using clinical photographs, outpatient clinic records, and operative records, information was recorded regarding concurrent congenital anomalies, postoperative complications, and follow-up. Using Photoshop CS2, the length of both sides of the lip was compared. The ratio of these lengths was calculated to evaluate lip symmetry. Results Of the patients treated at the Department of Plastic and Reconstructive Surgery at Kyungpook National University Chilgok Hospital, 11 (male-to-female sex ratio, 7:4) were diagnosed with Tessier number 7 craniofacial cleft. Concurrent congenital anomalies included skin tag, hemifacial microsomia, and cleft palate. The mean duration of follow-up was $78.273{\pm}72.219$ months and the mean ratio of the lengths of both sides of the lip was $1.048{\pm}0.071$. Scar widening occurred as a postoperative complication in some patients. No cases of wound infection, bleeding, or wound dehiscence occurred. Conclusions For the successful correction of macrostomia, plastic surgeons should consider both functional and aesthetic problems of the lip. Adequate repair of the orbicularis oris muscle, skin closure with Z-plasty, and medial overcorrection of the neo-oral commissure led to good results in our patients.

• Korean Journal of Cleft Lip And Palate
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• v.13 no.1
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• pp.29-34
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• 2010

구순구개열은 두경부에서 가장 흔히 발생하는 선천적 기형 중 하나로 554명 중 1명의 빈도로 나타나며 인종에 따라 다양하다. 구순구개열 환아들은 다른 선천적 기형을 동반하여 나타나는 경우가 흔하며, 그 빈도는 문헌에 따라 다르지만 1.5~63.4%로 나타난다. 새열낭종은 두번째 인두강의 폐쇄부전으로 나타나는 선천적 결손으로, 주로 흉쇄유돌근 전방에 나타난다. 구순구개열 환자에 있어 새열낭종을 동반하는 경우는 매우 드물다. 전북대학교 구강악안면외과학 교실에서는 새열낭종을 동반한 구순열 환아 1례를 경험하였다. 환아는 우측 불완전 편측성 구순열로 내원하여, 구순성형술과 함께 우측 목에 존재하던 새열낭종에 대한 제거 수술을 시행하였다. 환아는 출생 당시부터 심실중격결손 및 동맥관개존증 등의 선천적 심장질환 및 갑상선 기능저하증을 가지고 있던 환아로 다양한 선천적인 결손을 동반한 본 환아의 증례를 문헌고찰과 함께 보고하는 바이다.

• Korean Journal of Cleft Lip And Palate
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• v.6 no.1
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• pp.53-58
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• 2003

Lateral facial cleft is a rare congenital craniofacial anomaly. Their incidence is about 1 in 60,000 births and early treatment with closure in layers is important. Surgical treatment must reconstruct an anatomic and functional situation which give a good esthetic result. This study reports two cases of male at 31 months and 9 months suffered from esthetic problems due to lateral displacement of the oral commisure on the right side. Surgical treatment; the mucosa is closed in with a Z-plasty to avoid intraoral band contracture, the orbicularis oris muscle is closed after interfiber reorientation, and the skin is closed with multiple Z-plasty. So we report two cases of unilateral lateral facial cleft and review of etiopathogenesis in children with lateral facial cleft.